Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SYPHILIS NON TREP QUAL RPR

Facility

$58.00

Service Code	CPT 86592
Hospital Charge Code	900913673
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 SYPHILIS NON TREP QUANT

Facility

$39.00

Service Code	CPT 86593
Hospital Charge Code	900913672
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 SYPHILIS NON TREP QUANT

Facility

$58.00

Service Code	CPT 86593
Hospital Charge Code	900913672
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 SYPHILIS TOTAL

Facility

$39.00

Service Code	CPT 83516
Hospital Charge Code	900913674
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 SYPHILIS TOTAL

Facility

$58.00

Service Code	CPT 83516
Hospital Charge Code	900913674
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 SYPHILLIS IGG

Facility

$137.00

Service Code	CPT 86780
Hospital Charge Code	900913561
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 SYPHILLIS IGG

Facility

$26.00

Service Code	CPT 86780
Hospital Charge Code	900913561
Hospital Revenue Code	302
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 SYPHILLIS IGG INDIVIDUAL

Facility

$137.00

Service Code	CPT 86780
Hospital Charge Code	900913563
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 SYPHILLIS IGG INDIVIDUAL

Facility

$137.00

Service Code	CPT 86780
Hospital Charge Code	900913563
Hospital Revenue Code	302
Min. Negotiated Rate	$75.35
Max. Negotiated Rate	$102.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$82.20
Rate for Payer: Aetna of CA Government/Medicare	$82.20
Rate for Payer: Cash Price	$61.65
Rate for Payer: Health Smart Auto/Commercial	$82.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$82.20
Rate for Payer: LLUH Dept of Risk Management WC	$75.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$102.75

HC SYPHILLIS TEST RPR

Facility

$12.00

Service Code	CPT 86592
Hospital Charge Code	900910892
Hospital Revenue Code	302
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 SYPHILLIS TEST RPR

Facility

$137.00

Service Code	CPT 86592
Hospital Charge Code	900910892
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 SYPHILLIS TEST RPR INDIVIDUAL

Facility

$137.00

Service Code	CPT 86592
Hospital Charge Code	900912331
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 SYPHILLIS TEST RPR INDIVIDUAL

Facility

$12.00

Service Code	CPT 86592
Hospital Charge Code	900912331
Hospital Revenue Code	302
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 SYPHILLIS TEST VDRL/ CSF

Facility

$17.00

Service Code	CPT 86592
Hospital Charge Code	900910861
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 SYPHILLIS TEST VDRL/ CSF

Facility

$137.00

Service Code	CPT 86592
Hospital Charge Code	900910861
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 TESTOSTERONE TOTAL

Facility

$308.00

Service Code	CPT 84403
Hospital Charge Code	900912134
Hospital Revenue Code	301
Min. Negotiated Rate	$169.40
Max. Negotiated Rate	$246.40
Rate for Payer: Cash Price	$138.60
Rate for Payer: Cigna of CA HMO/PPO	$246.40
Rate for Payer: Health Smart Auto/Commercial	$184.80
Rate for Payer: LLUH Dept of Risk Management WC	$169.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$231.00

HC TESTOSTERONE TOTAL

Facility

$50.00

Service Code	CPT 84403
Hospital Charge Code	900912134
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.50

HC TEST URINE VOLUME

Facility

$89.00

Service Code	CPT 81050
Hospital Charge Code	900910797
Hospital Revenue Code	301
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 TEST URINE VOLUME

Facility

$11.00

Service Code	CPT 81050
Hospital Charge Code	900910797
Hospital Revenue Code	301
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 TETRACYCLINE E TEST

Facility

$11.00

Service Code	CPT 87181
Hospital Charge Code	900912444
Hospital Revenue Code	306
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 TETRACYCLINE E TEST

Facility

$108.00

Service Code	CPT 87181
Hospital Charge Code	900912444
Hospital Revenue Code	306
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$86.40
Rate for Payer: Cash Price	$48.60
Rate for Payer: Cigna of CA HMO/PPO	$86.40
Rate for Payer: Health Smart Auto/Commercial	$64.80
Rate for Payer: LLUH Dept of Risk Management WC	$59.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$81.00

HC THEOPHYLLINE

Facility

$204.00

Service Code	CPT 80198
Hospital Charge Code	900910457
Hospital Revenue Code	301
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$163.20
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna of CA HMO/PPO	$163.20
Rate for Payer: Health Smart Auto/Commercial	$122.40
Rate for Payer: LLUH Dept of Risk Management WC	$112.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$153.00

HC THEOPHYLLINE

Facility

$50.00

Service Code	CPT 80198
Hospital Charge Code	900910457
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.50

HC THIOCYANATE SERUM

Facility

$460.00

Service Code	CPT 84430
Hospital Charge Code	900910463
Hospital Revenue Code	301
Min. Negotiated Rate	$253.00
Max. Negotiated Rate	$368.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cigna of CA HMO/PPO	$368.00
Rate for Payer: Health Smart Auto/Commercial	$276.00
Rate for Payer: LLUH Dept of Risk Management WC	$253.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$345.00

HC THIOCYANATE SERUM

Facility

$45.00

Service Code	CPT 84430
Hospital Charge Code	900910463
Hospital Revenue Code	301
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.00
Rate for Payer: Aetna of CA Government/Medicare	$27.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

Know your out-of-pocket cost for care.

All Charges