Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOQ 26477 ASPERG IGM 86606

Facility

$173.00

Service Code	CPT 86606
Hospital Charge Code	900914876
Hospital Revenue Code	302
Min. Negotiated Rate	$95.15
Max. Negotiated Rate	$138.40
Rate for Payer: Cash Price	$77.85
Rate for Payer: Cigna of CA HMO/PPO	$138.40
Rate for Payer: Health Smart Auto/Commercial	$103.80
Rate for Payer: LLUH Dept of Risk Management WC	$95.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$129.75

HC SOQ 26477 ASPERG IGM 86606

Facility

$173.00

Service Code	CPT 86606 90
Hospital Charge Code	900914876
Hospital Revenue Code	302
Min. Negotiated Rate	$95.15
Max. Negotiated Rate	$138.40
Rate for Payer: Cash Price	$77.85
Rate for Payer: Cigna of CA HMO/PPO	$138.40
Rate for Payer: Health Smart Auto/Commercial	$103.80
Rate for Payer: LLUH Dept of Risk Management WC	$95.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$129.75

HC SOQ 26477 ASPERG IGM 86606

Facility

$173.00

Service Code	CPT 86606 90
Hospital Charge Code	900914876
Hospital Revenue Code	302
Min. Negotiated Rate	$95.15
Max. Negotiated Rate	$129.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$103.80
Rate for Payer: Aetna of CA Government/Medicare	$103.80
Rate for Payer: Cash Price	$77.85
Rate for Payer: Health Smart Auto/Commercial	$103.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$103.80
Rate for Payer: LLUH Dept of Risk Management WC	$95.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$129.75

HC SOQ 26477 ASPERG IGM 86606

Facility

$173.00

Service Code	CPT 86606
Hospital Charge Code	900914876
Hospital Revenue Code	302
Min. Negotiated Rate	$95.15
Max. Negotiated Rate	$129.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$103.80
Rate for Payer: Aetna of CA Government/Medicare	$103.80
Rate for Payer: Cash Price	$77.85
Rate for Payer: Health Smart Auto/Commercial	$103.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$103.80
Rate for Payer: LLUH Dept of Risk Management WC	$95.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$129.75

HC SOSB MICRO ARTHROPOD EXAM

Facility

$10.00

Service Code	CPT 87220 90
Hospital Charge Code	900915252
Hospital Revenue Code	306
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.00
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cigna of CA HMO/PPO	$8.00
Rate for Payer: Health Smart Auto/Commercial	$6.00
Rate for Payer: LLUH Dept of Risk Management WC	$5.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.50

HC SOSB MICRO ARTHROPOD EXAM

Facility

$10.00

Service Code	CPT 87220
Hospital Charge Code	900915252
Hospital Revenue Code	306
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 SOSB MICRO ARTHROPOD EXAM

Facility

$10.00

Service Code	CPT 87220
Hospital Charge Code	900915252
Hospital Revenue Code	306
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.00
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cigna of CA HMO/PPO	$8.00
Rate for Payer: Health Smart Auto/Commercial	$6.00
Rate for Payer: LLUH Dept of Risk Management WC	$5.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.50

HC SOSB MICRO ARTHROPOD EXAM

Facility

$10.00

Service Code	CPT 87220 90
Hospital Charge Code	900915252
Hospital Revenue Code	306
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 SOSPH MTB PCR SPUTUM

Facility

$100.00

Service Code	CPT 87556
Hospital Charge Code	900915436
Hospital Revenue Code	300
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$80.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna of CA HMO/PPO	$80.00
Rate for Payer: Health Smart Auto/Commercial	$60.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$75.00

HC SOSPH MTB PCR SPUTUM

Facility

$100.00

Service Code	CPT 87556
Hospital Charge Code	900915436
Hospital Revenue Code	300
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$60.00
Rate for Payer: Aetna of CA Government/Medicare	$60.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Smart Auto/Commercial	$60.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$60.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$75.00

HC SOSPH MTB PCR SPUTUM

Facility

$100.00

Service Code	CPT 87556 90
Hospital Charge Code	900915436
Hospital Revenue Code	300
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$80.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna of CA HMO/PPO	$80.00
Rate for Payer: Health Smart Auto/Commercial	$60.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$75.00

HC SOSPH MTB PCR SPUTUM

Facility

$100.00

Service Code	CPT 87556 90
Hospital Charge Code	900915436
Hospital Revenue Code	300
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$60.00
Rate for Payer: Aetna of CA Government/Medicare	$60.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Smart Auto/Commercial	$60.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$60.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$75.00

HC SOUCI METHOTREXATE

Facility

$55.00

Service Code	CPT 80229
Hospital Charge Code	900915251
Hospital Revenue Code	301
Min. Negotiated Rate	$30.25
Max. Negotiated Rate	$44.00
Rate for Payer: Cash Price	$24.75
Rate for Payer: Cigna of CA HMO/PPO	$44.00
Rate for Payer: Health Smart Auto/Commercial	$33.00
Rate for Payer: LLUH Dept of Risk Management WC	$30.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$41.25

HC SOUCI METHOTREXATE

Facility

$55.00

Service Code	CPT 80229 90
Hospital Charge Code	900915251
Hospital Revenue Code	301
Min. Negotiated Rate	$30.25
Max. Negotiated Rate	$44.00
Rate for Payer: Cash Price	$24.75
Rate for Payer: Cigna of CA HMO/PPO	$44.00
Rate for Payer: Health Smart Auto/Commercial	$33.00
Rate for Payer: LLUH Dept of Risk Management WC	$30.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$41.25

HC SOUCI METHOTREXATE

Facility

$55.00

Service Code	CPT 80229 90
Hospital Charge Code	900915251
Hospital Revenue Code	301
Min. Negotiated Rate	$30.25
Max. Negotiated Rate	$41.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$33.00
Rate for Payer: Aetna of CA Government/Medicare	$33.00
Rate for Payer: Cash Price	$24.75
Rate for Payer: Health Smart Auto/Commercial	$33.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$33.00
Rate for Payer: LLUH Dept of Risk Management WC	$30.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$41.25

HC SOUCI METHOTREXATE

Facility

$55.00

Service Code	CPT 80229
Hospital Charge Code	900915251
Hospital Revenue Code	301
Min. Negotiated Rate	$30.25
Max. Negotiated Rate	$41.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$33.00
Rate for Payer: Aetna of CA Government/Medicare	$33.00
Rate for Payer: Cash Price	$24.75
Rate for Payer: Health Smart Auto/Commercial	$33.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$33.00
Rate for Payer: LLUH Dept of Risk Management WC	$30.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$41.25

HC SPEC GRAVITY HEMATOLOGY

Facility

$12.00

Service Code	CPT 81002
Hospital Charge Code	900910178
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 SPEC GRAVITY HEMATOLOGY

Facility

$82.00

Service Code	CPT 81002
Hospital Charge Code	900910178
Hospital Revenue Code	307
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 SPECIMEN HANDLING

Facility

$28.00

Service Code	CPT 99001
Hospital Charge Code	900910091
Hospital Revenue Code	300
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.80
Rate for Payer: Aetna of CA Government/Medicare	$16.80
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Smart Auto/Commercial	$16.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.80
Rate for Payer: LLUH Dept of Risk Management WC	$15.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21.00

HC SPECIMEN HANDLING

Facility

$28.00

Service Code	CPT 99000
Hospital Charge Code	900910091
Hospital Revenue Code	300
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.80
Rate for Payer: Aetna of CA Government/Medicare	$16.80
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Smart Auto/Commercial	$16.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.80
Rate for Payer: LLUH Dept of Risk Management WC	$15.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21.00

HC SPECIMEN HANDLING

Facility

$89.00

Service Code	CPT 99001
Hospital Charge Code	900910091
Hospital Revenue Code	300
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 SPECIMEN HANDLING

Facility

$89.00

Service Code	CPT 99000
Hospital Charge Code	900910091
Hospital Revenue Code	300
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 SPINE 2-3 VIEWS

Facility

$1,020.00

Service Code	CPT 72040
Hospital Charge Code	909001302
Hospital Revenue Code	320
Min. Negotiated Rate	$561.00
Max. Negotiated Rate	$816.00
Rate for Payer: Cash Price	$459.00
Rate for Payer: Cigna of CA HMO/PPO	$816.00
Rate for Payer: Health Smart Auto/Commercial	$612.00
Rate for Payer: LLUH Dept of Risk Management WC	$561.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$765.00

HC SPINE 2-3 VIEWS

Facility

$1,020.00

Service Code	CPT 72040
Hospital Charge Code	909001302
Hospital Revenue Code	320
Min. Negotiated Rate	$561.00
Max. Negotiated Rate	$765.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$612.00
Rate for Payer: Aetna of CA Government/Medicare	$612.00
Rate for Payer: Cash Price	$459.00
Rate for Payer: Health Smart Auto/Commercial	$612.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$612.00
Rate for Payer: LLUH Dept of Risk Management WC	$561.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$765.00

HC SPINE 2-3 VIEWS

Facility

$1,020.00

Service Code	CPT 72040 TC
Hospital Charge Code	909001302
Hospital Revenue Code	320
Min. Negotiated Rate	$561.00
Max. Negotiated Rate	$765.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$612.00
Rate for Payer: Aetna of CA Government/Medicare	$612.00
Rate for Payer: Cash Price	$459.00
Rate for Payer: Health Smart Auto/Commercial	$612.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$612.00
Rate for Payer: LLUH Dept of Risk Management WC	$561.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$765.00

Know your out-of-pocket cost for care.

All Charges