Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC GAMMA GLUTAMYL TRANSFERASE

Facility

$270.00

Service Code	CPT 82977
Hospital Charge Code	900910225
Hospital Revenue Code	301
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$216.00
Rate for Payer: Cash Price	$121.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$216.00
Rate for Payer: Health Smart Auto/Commercial	$162.00
Rate for Payer: LLUH Dept of Risk Management WC	$148.50
Rate for Payer: Multiplan Commercial	$202.50

HC GAMMA GLUTAMYL TRANSFERASE

Facility

$44.00

Service Code	CPT 82977
Hospital Charge Code	900910225
Hospital Revenue Code	301
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$26.40
Rate for Payer: Aetna of CA Government/Medicare	$26.40
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$35.20
Rate for Payer: Health Smart Auto/Commercial	$26.40
Rate for Payer: Intervalley Health Plan Commercial	$7.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$26.40
Rate for Payer: LLUH Dept of Risk Management WC	$24.20
Rate for Payer: Multiplan Commercial	$33.00

HC GASTRO PANEL NUCLEIC ACID

Facility

$1,482.00

Service Code	CPT 87507
Hospital Charge Code	900913644
Hospital Revenue Code	300
Min. Negotiated Rate	$416.78
Max. Negotiated Rate	$1,185.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$889.20
Rate for Payer: Aetna of CA Government/Medicare	$889.20
Rate for Payer: Cash Price	$666.90
Rate for Payer: Cash Price	$666.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,185.60
Rate for Payer: Health Smart Auto/Commercial	$889.20
Rate for Payer: Intervalley Health Plan Commercial	$416.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$889.20
Rate for Payer: LLUH Dept of Risk Management WC	$815.10
Rate for Payer: Multiplan Commercial	$1,111.50

HC GASTRO PANEL NUCLEIC ACID

Facility

$1,762.00

Service Code	CPT 87507
Hospital Charge Code	900913644
Hospital Revenue Code	300
Min. Negotiated Rate	$969.10
Max. Negotiated Rate	$1,409.60
Rate for Payer: Cash Price	$792.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,409.60
Rate for Payer: Health Smart Auto/Commercial	$1,057.20
Rate for Payer: LLUH Dept of Risk Management WC	$969.10
Rate for Payer: Multiplan Commercial	$1,321.50

HC GASTRO UGI SMB W WO KUB

Facility

$1,906.00

Service Code	CPT 74245
Hospital Charge Code	909001811
Hospital Revenue Code	320
Min. Negotiated Rate	$1,048.30
Max. Negotiated Rate	$1,524.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,143.60
Rate for Payer: Aetna of CA Government/Medicare	$1,143.60
Rate for Payer: Cash Price	$857.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,524.80
Rate for Payer: Health Smart Auto/Commercial	$1,143.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,143.60
Rate for Payer: LLUH Dept of Risk Management WC	$1,048.30
Rate for Payer: Multiplan Commercial	$1,429.50

HC GASTRO UGI SMB W WO KUB

Facility

$1,906.00

Service Code	CPT 74245
Hospital Charge Code	909001811
Hospital Revenue Code	320
Min. Negotiated Rate	$1,048.30
Max. Negotiated Rate	$1,524.80
Rate for Payer: Cash Price	$857.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,524.80
Rate for Payer: Health Smart Auto/Commercial	$1,143.60
Rate for Payer: LLUH Dept of Risk Management WC	$1,048.30
Rate for Payer: Multiplan Commercial	$1,429.50

HC GENTAMICIN

Facility

$218.00

Service Code	CPT 80170
Hospital Charge Code	900910406
Hospital Revenue Code	301
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$174.40
Rate for Payer: Cash Price	$98.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$174.40
Rate for Payer: Health Smart Auto/Commercial	$130.80
Rate for Payer: LLUH Dept of Risk Management WC	$119.90
Rate for Payer: Multiplan Commercial	$163.50

HC GENTAMICIN

Facility

$49.00

Service Code	CPT 80170
Hospital Charge Code	900910406
Hospital Revenue Code	301
Min. Negotiated Rate	$16.38
Max. Negotiated Rate	$39.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$29.40
Rate for Payer: Aetna of CA Government/Medicare	$29.40
Rate for Payer: Cash Price	$22.05
Rate for Payer: Cash Price	$22.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$39.20
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: Intervalley Health Plan Commercial	$16.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$29.40
Rate for Payer: LLUH Dept of Risk Management WC	$26.95
Rate for Payer: Multiplan Commercial	$36.75

HC GLIADIN AB IGA

Facility

$78.00

Service Code	CPT 83516
Hospital Charge Code	900913558
Hospital Revenue Code	302
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$62.40
Rate for Payer: Cash Price	$35.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$62.40
Rate for Payer: Health Smart Auto/Commercial	$46.80
Rate for Payer: LLUH Dept of Risk Management WC	$42.90
Rate for Payer: Multiplan Commercial	$58.50

HC GLIADIN AB IGA

Facility

$54.00

Service Code	CPT 83516
Hospital Charge Code	900913558
Hospital Revenue Code	302
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$32.40
Rate for Payer: Aetna of CA Government/Medicare	$32.40
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cash Price	$24.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$43.20
Rate for Payer: Health Smart Auto/Commercial	$32.40
Rate for Payer: Intervalley Health Plan Commercial	$11.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$32.40
Rate for Payer: LLUH Dept of Risk Management WC	$29.70
Rate for Payer: Multiplan Commercial	$40.50

HC GLIADIN AB IGG

Facility

$78.00

Service Code	CPT 83516
Hospital Charge Code	900913557
Hospital Revenue Code	302
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$62.40
Rate for Payer: Cash Price	$35.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$62.40
Rate for Payer: Health Smart Auto/Commercial	$46.80
Rate for Payer: LLUH Dept of Risk Management WC	$42.90
Rate for Payer: Multiplan Commercial	$58.50

HC GLIADIN AB IGG

Facility

$54.00

Service Code	CPT 83516
Hospital Charge Code	900913557
Hospital Revenue Code	302
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$32.40
Rate for Payer: Aetna of CA Government/Medicare	$32.40
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cash Price	$24.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$43.20
Rate for Payer: Health Smart Auto/Commercial	$32.40
Rate for Payer: Intervalley Health Plan Commercial	$11.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$32.40
Rate for Payer: LLUH Dept of Risk Management WC	$29.70
Rate for Payer: Multiplan Commercial	$40.50

HC GLIADIN IGA

Facility

$64.00

Service Code	CPT 83516
Hospital Charge Code	900913658
Hospital Revenue Code	302
Min. Negotiated Rate	$35.20
Max. Negotiated Rate	$51.20
Rate for Payer: Cash Price	$28.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$51.20
Rate for Payer: Health Smart Auto/Commercial	$38.40
Rate for Payer: LLUH Dept of Risk Management WC	$35.20
Rate for Payer: Multiplan Commercial	$48.00

HC GLIADIN IGA

Facility

$49.00

Service Code	CPT 83516
Hospital Charge Code	900913658
Hospital Revenue Code	302
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$39.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$29.40
Rate for Payer: Aetna of CA Government/Medicare	$29.40
Rate for Payer: Cash Price	$22.05
Rate for Payer: Cash Price	$22.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$39.20
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: Intervalley Health Plan Commercial	$11.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$29.40
Rate for Payer: LLUH Dept of Risk Management WC	$26.95
Rate for Payer: Multiplan Commercial	$36.75

HC GLIADIN IGG

Facility

$64.00

Service Code	CPT 83516
Hospital Charge Code	900913659
Hospital Revenue Code	302
Min. Negotiated Rate	$35.20
Max. Negotiated Rate	$51.20
Rate for Payer: Cash Price	$28.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$51.20
Rate for Payer: Health Smart Auto/Commercial	$38.40
Rate for Payer: LLUH Dept of Risk Management WC	$35.20
Rate for Payer: Multiplan Commercial	$48.00

HC GLIADIN IGG

Facility

$49.00

Service Code	CPT 83516
Hospital Charge Code	900913659
Hospital Revenue Code	302
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$39.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$29.40
Rate for Payer: Aetna of CA Government/Medicare	$29.40
Rate for Payer: Cash Price	$22.05
Rate for Payer: Cash Price	$22.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$39.20
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: Intervalley Health Plan Commercial	$11.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$29.40
Rate for Payer: LLUH Dept of Risk Management WC	$26.95
Rate for Payer: Multiplan Commercial	$36.75

HC GLUCOSE

Facility

$98.00

Service Code	CPT 82947
Hospital Charge Code	900910498
Hospital Revenue Code	301
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$78.40
Rate for Payer: Cash Price	$44.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$78.40
Rate for Payer: Health Smart Auto/Commercial	$58.80
Rate for Payer: LLUH Dept of Risk Management WC	$53.90
Rate for Payer: Multiplan Commercial	$73.50

HC GLUCOSE

Facility

$42.00

Service Code	CPT 82947
Hospital Charge Code	900910498
Hospital Revenue Code	301
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$33.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$25.20
Rate for Payer: Aetna of CA Government/Medicare	$25.20
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$33.60
Rate for Payer: Health Smart Auto/Commercial	$25.20
Rate for Payer: Intervalley Health Plan Commercial	$3.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$25.20
Rate for Payer: LLUH Dept of Risk Management WC	$23.10
Rate for Payer: Multiplan Commercial	$31.50

HC GLUCOSE ADDITIONAL

Facility

$86.00

Service Code	CPT 82952
Hospital Charge Code	900910444
Hospital Revenue Code	301
Min. Negotiated Rate	$47.30
Max. Negotiated Rate	$68.80
Rate for Payer: Cash Price	$38.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$68.80
Rate for Payer: Health Smart Auto/Commercial	$51.60
Rate for Payer: LLUH Dept of Risk Management WC	$47.30
Rate for Payer: Multiplan Commercial	$64.50

HC GLUCOSE ADDITIONAL

Facility

$42.00

Service Code	CPT 82952
Hospital Charge Code	900910444
Hospital Revenue Code	301
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$33.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$25.20
Rate for Payer: Aetna of CA Government/Medicare	$25.20
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$33.60
Rate for Payer: Health Smart Auto/Commercial	$25.20
Rate for Payer: Intervalley Health Plan Commercial	$3.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$25.20
Rate for Payer: LLUH Dept of Risk Management WC	$23.10
Rate for Payer: Multiplan Commercial	$31.50

HC GLUCOSE BODY FLUID

Facility

$42.00

Service Code	CPT 82945
Hospital Charge Code	900912249
Hospital Revenue Code	301
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$33.60
Rate for Payer: Cash Price	$18.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$33.60
Rate for Payer: Health Smart Auto/Commercial	$25.20
Rate for Payer: LLUH Dept of Risk Management WC	$23.10
Rate for Payer: Multiplan Commercial	$31.50

HC GLUCOSE BODY FLUID

Facility

$37.00

Service Code	CPT 82945
Hospital Charge Code	900912249
Hospital Revenue Code	301
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$29.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.20
Rate for Payer: Aetna of CA Government/Medicare	$22.20
Rate for Payer: Cash Price	$16.65
Rate for Payer: Cash Price	$16.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$29.60
Rate for Payer: Health Smart Auto/Commercial	$22.20
Rate for Payer: Intervalley Health Plan Commercial	$3.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.20
Rate for Payer: LLUH Dept of Risk Management WC	$20.35
Rate for Payer: Multiplan Commercial	$27.75

HC GLUCOSE CSF

Facility

$42.00

Service Code	CPT 82945
Hospital Charge Code	900910305
Hospital Revenue Code	301
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$33.60
Rate for Payer: Cash Price	$18.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$33.60
Rate for Payer: Health Smart Auto/Commercial	$25.20
Rate for Payer: LLUH Dept of Risk Management WC	$23.10
Rate for Payer: Multiplan Commercial	$31.50

HC GLUCOSE CSF

Facility

$37.00

Service Code	CPT 82945
Hospital Charge Code	900910305
Hospital Revenue Code	301
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$29.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.20
Rate for Payer: Aetna of CA Government/Medicare	$22.20
Rate for Payer: Cash Price	$16.65
Rate for Payer: Cash Price	$16.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$29.60
Rate for Payer: Health Smart Auto/Commercial	$22.20
Rate for Payer: Intervalley Health Plan Commercial	$3.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.20
Rate for Payer: LLUH Dept of Risk Management WC	$20.35
Rate for Payer: Multiplan Commercial	$27.75

HC GLUCOSE FASTING

Facility

$98.00

Service Code	CPT 82947
Hospital Charge Code	900910306
Hospital Revenue Code	301
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$78.40
Rate for Payer: Cash Price	$44.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$78.40
Rate for Payer: Health Smart Auto/Commercial	$58.80
Rate for Payer: LLUH Dept of Risk Management WC	$53.90
Rate for Payer: Multiplan Commercial	$73.50

Know your out-of-pocket cost for care.

All Charges