Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC GLUCOSE FASTING

Facility

$42.00

Service Code	CPT 82947
Hospital Charge Code	900910306
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 LOADING 1 HR

Facility

$105.00

Service Code	CPT 82950
Hospital Charge Code	900910314
Hospital Revenue Code	301
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$84.00
Rate for Payer: Cash Price	$47.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$84.00
Rate for Payer: Health Smart Auto/Commercial	$63.00
Rate for Payer: LLUH Dept of Risk Management WC	$57.75
Rate for Payer: Multiplan Commercial	$78.75

HC GLUCOSE LOADING 1 HR

Facility

$36.00

Service Code	CPT 82950
Hospital Charge Code	900910314
Hospital Revenue Code	301
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$28.80
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: Cash Price	$16.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$28.80
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: Intervalley Health Plan Commercial	$4.75
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 Commercial	$27.00

HC GLUCOSE RANDOM

Facility

$42.00

Service Code	CPT 82947
Hospital Charge Code	900910307
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 RANDOM

Facility

$98.00

Service Code	CPT 82947
Hospital Charge Code	900910307
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 TESTING POC

Facility

$137.00

Service Code	CPT 82962
Hospital Charge Code	900910468
Hospital Revenue Code	301
Min. Negotiated Rate	$75.35
Max. Negotiated Rate	$109.60
Rate for Payer: Cash Price	$61.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$102.75

HC GLUCOSE TESTING POC

Facility

$13.00

Service Code	CPT 82962
Hospital Charge Code	900910468
Hospital Revenue Code	301
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$10.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.80
Rate for Payer: Aetna of CA Government/Medicare	$7.80
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cash Price	$5.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.40
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: Intervalley Health Plan Commercial	$3.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Commercial	$9.75

HC GLUCOSE TOLERANCE TEST 2 HR

Facility

$226.00

Service Code	CPT 82951
Hospital Charge Code	900910208
Hospital Revenue Code	301
Min. Negotiated Rate	$124.30
Max. Negotiated Rate	$180.80
Rate for Payer: Cash Price	$101.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$180.80
Rate for Payer: Health Smart Auto/Commercial	$135.60
Rate for Payer: LLUH Dept of Risk Management WC	$124.30
Rate for Payer: Multiplan Commercial	$169.50

HC GLUCOSE TOLERANCE TEST 2 HR

Facility

$118.00

Service Code	CPT 82951
Hospital Charge Code	900910208
Hospital Revenue Code	301
Min. Negotiated Rate	$12.87
Max. Negotiated Rate	$94.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$70.80
Rate for Payer: Aetna of CA Government/Medicare	$70.80
Rate for Payer: Cash Price	$53.10
Rate for Payer: Cash Price	$53.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$94.40
Rate for Payer: Health Smart Auto/Commercial	$70.80
Rate for Payer: Intervalley Health Plan Commercial	$12.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$70.80
Rate for Payer: LLUH Dept of Risk Management WC	$64.90
Rate for Payer: Multiplan Commercial	$88.50

HC GLUCOSE TOLERANCE TEST 3 HR

Facility

$118.00

Service Code	CPT 82951
Hospital Charge Code	900910308
Hospital Revenue Code	301
Min. Negotiated Rate	$12.87
Max. Negotiated Rate	$94.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$70.80
Rate for Payer: Aetna of CA Government/Medicare	$70.80
Rate for Payer: Cash Price	$53.10
Rate for Payer: Cash Price	$53.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$94.40
Rate for Payer: Health Smart Auto/Commercial	$70.80
Rate for Payer: Intervalley Health Plan Commercial	$12.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$70.80
Rate for Payer: LLUH Dept of Risk Management WC	$64.90
Rate for Payer: Multiplan Commercial	$88.50

HC GLUCOSE TOLERANCE TEST 3 HR

Facility

$226.00

Service Code	CPT 82951
Hospital Charge Code	900910308
Hospital Revenue Code	301
Min. Negotiated Rate	$124.30
Max. Negotiated Rate	$180.80
Rate for Payer: Cash Price	$101.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$180.80
Rate for Payer: Health Smart Auto/Commercial	$135.60
Rate for Payer: LLUH Dept of Risk Management WC	$124.30
Rate for Payer: Multiplan Commercial	$169.50

HC GLUCOSE URINE

Facility

$42.00

Service Code	CPT 82945
Hospital Charge Code	900910311
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 URINE

Facility

$54.00

Service Code	CPT 82945
Hospital Charge Code	900910311
Hospital Revenue Code	301
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$43.20
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: LLUH Dept of Risk Management WC	$29.70
Rate for Payer: Multiplan Commercial	$40.50

HC GRAM POSITIVE SENSITIVITY MIC

Facility

$74.00

Service Code	CPT 87186
Hospital Charge Code	900912491
Hospital Revenue Code	300
Min. Negotiated Rate	$40.70
Max. Negotiated Rate	$59.20
Rate for Payer: Cash Price	$33.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$59.20
Rate for Payer: Health Smart Auto/Commercial	$44.40
Rate for Payer: LLUH Dept of Risk Management WC	$40.70
Rate for Payer: Multiplan Commercial	$55.50

HC GRAM POSITIVE SENSITIVITY MIC

Facility

$64.00

Service Code	CPT 87186
Hospital Charge Code	900912491
Hospital Revenue Code	300
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$51.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$38.40
Rate for Payer: Aetna of CA Government/Medicare	$38.40
Rate for Payer: Cash Price	$28.80
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: Intervalley Health Plan Commercial	$8.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$38.40
Rate for Payer: LLUH Dept of Risk Management WC	$35.20
Rate for Payer: Multiplan Commercial	$48.00

HC GRAM STAIN

Facility

$46.00

Service Code	CPT 87205
Hospital Charge Code	900911705
Hospital Revenue Code	306
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$36.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.60
Rate for Payer: Aetna of CA Government/Medicare	$27.60
Rate for Payer: Cash Price	$20.70
Rate for Payer: Cash Price	$20.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$36.80
Rate for Payer: Health Smart Auto/Commercial	$27.60
Rate for Payer: Intervalley Health Plan Commercial	$4.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.60
Rate for Payer: LLUH Dept of Risk Management WC	$25.30
Rate for Payer: Multiplan Commercial	$34.50

HC GRAM STAIN

Facility

$156.00

Service Code	CPT 87205
Hospital Charge Code	900911705
Hospital Revenue Code	306
Min. Negotiated Rate	$85.80
Max. Negotiated Rate	$124.80
Rate for Payer: Cash Price	$70.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$124.80
Rate for Payer: Health Smart Auto/Commercial	$93.60
Rate for Payer: LLUH Dept of Risk Management WC	$85.80
Rate for Payer: Multiplan Commercial	$117.00

HC GROUP PSYCHOTHERAPY-MOTIVATION

Facility

$430.00

Service Code	CPT 90853
Hospital Charge Code	907804018
Hospital Revenue Code	912
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$510.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$236.50
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$322.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC GROUP PSYCHOTHERAPY-MOTIVATION

Facility

$430.00

Service Code	CPT 90853
Hospital Charge Code	907804018
Hospital Revenue Code	912
Min. Negotiated Rate	$236.50
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$344.00
Rate for Payer: Health Smart Auto/Commercial	$258.00
Rate for Payer: LLUH Dept of Risk Management WC	$236.50
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$322.50

HC GROUP THERAPY 60 MIN

Facility

$528.00

Service Code	CPT 90853
Hospital Charge Code	903100090
Hospital Revenue Code	905
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$364.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$290.40
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$396.00
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC GROUP THERAPY 60 MIN

Facility

$528.00

Service Code	CPT 90853
Hospital Charge Code	903100090
Hospital Revenue Code	905
Min. Negotiated Rate	$290.40
Max. Negotiated Rate	$652.36
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$422.40
Rate for Payer: Health Smart Auto/Commercial	$316.80
Rate for Payer: LLUH Dept of Risk Management WC	$290.40
Rate for Payer: Mary Free Bed Workers' Compensation	$652.36
Rate for Payer: Multiplan Commercial	$396.00

HC HAND COMPLETE MIN 3 VIEWS

Facility

$1,079.00

Service Code	CPT 73130
Hospital Charge Code	909001520
Hospital Revenue Code	320
Min. Negotiated Rate	$593.45
Max. Negotiated Rate	$863.20
Rate for Payer: Cash Price	$485.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$863.20
Rate for Payer: Health Smart Auto/Commercial	$647.40
Rate for Payer: LLUH Dept of Risk Management WC	$593.45
Rate for Payer: Multiplan Commercial	$809.25

HC HAND COMPLETE MIN 3 VIEWS

Facility

$1,079.00

Service Code	CPT 73130
Hospital Charge Code	909001520
Hospital Revenue Code	320
Min. Negotiated Rate	$593.45
Max. Negotiated Rate	$863.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$647.40
Rate for Payer: Aetna of CA Government/Medicare	$647.40
Rate for Payer: Cash Price	$485.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$863.20
Rate for Payer: Health Smart Auto/Commercial	$647.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$647.40
Rate for Payer: LLUH Dept of Risk Management WC	$593.45
Rate for Payer: Multiplan Commercial	$809.25

HC HAND LIMITED 2 VIEWS

Facility

$1,076.00

Service Code	CPT 73120
Hospital Charge Code	909001518
Hospital Revenue Code	320
Min. Negotiated Rate	$591.80
Max. Negotiated Rate	$860.80
Rate for Payer: Cash Price	$484.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$860.80
Rate for Payer: Health Smart Auto/Commercial	$645.60
Rate for Payer: LLUH Dept of Risk Management WC	$591.80
Rate for Payer: Multiplan Commercial	$807.00

HC HAND LIMITED 2 VIEWS

Facility

$1,076.00

Service Code	CPT 73120
Hospital Charge Code	909001518
Hospital Revenue Code	320
Min. Negotiated Rate	$591.80
Max. Negotiated Rate	$860.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$645.60
Rate for Payer: Aetna of CA Government/Medicare	$645.60
Rate for Payer: Cash Price	$484.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$860.80
Rate for Payer: Health Smart Auto/Commercial	$645.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$645.60
Rate for Payer: LLUH Dept of Risk Management WC	$591.80
Rate for Payer: Multiplan Commercial	$807.00

Know your out-of-pocket cost for care.

All Charges