Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC FOREARM

Facility

$790.00

Service Code	CPT 73090
Hospital Charge Code	909001513
Hospital Revenue Code	320
Min. Negotiated Rate	$434.50
Max. Negotiated Rate	$592.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$474.00
Rate for Payer: Aetna of CA Government/Medicare	$474.00
Rate for Payer: Cash Price	$355.50
Rate for Payer: Health Smart Auto/Commercial	$474.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$474.00
Rate for Payer: LLUH Dept of Risk Management WC	$434.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$592.50

HC FOREARM

Facility

$790.00

Service Code	CPT 73090 TC
Hospital Charge Code	909001513
Hospital Revenue Code	320
Min. Negotiated Rate	$434.50
Max. Negotiated Rate	$592.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$474.00
Rate for Payer: Aetna of CA Government/Medicare	$474.00
Rate for Payer: Cash Price	$355.50
Rate for Payer: Health Smart Auto/Commercial	$474.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$474.00
Rate for Payer: LLUH Dept of Risk Management WC	$434.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$592.50

HC FREE T4 BY EIA

Facility

$28.00

Service Code	CPT 84439
Hospital Charge Code	900912111
Hospital Revenue Code	301
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 FREE T4 BY EIA

Facility

$244.00

Service Code	CPT 84439
Hospital Charge Code	900912111
Hospital Revenue Code	301
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$195.20
Rate for Payer: Cash Price	$109.80
Rate for Payer: Cigna of CA HMO/PPO	$195.20
Rate for Payer: Health Smart Auto/Commercial	$146.40
Rate for Payer: LLUH Dept of Risk Management WC	$134.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$183.00

HC FSH

Facility

$36.00

Service Code	CPT 83001
Hospital Charge Code	900910818
Hospital Revenue Code	301
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 FSH

Facility

$244.00

Service Code	CPT 83001
Hospital Charge Code	900910818
Hospital Revenue Code	301
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$195.20
Rate for Payer: Health Smart Auto/Commercial	$146.40
Rate for Payer: Cash Price	$109.80
Rate for Payer: Cigna of CA HMO/PPO	$195.20
Rate for Payer: LLUH Dept of Risk Management WC	$134.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$183.00

HC GAMMA GLUTAMYL TRANSFERASE

Facility

$244.00

Service Code	CPT 82977
Hospital Charge Code	900910225
Hospital Revenue Code	301
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$195.20
Rate for Payer: Cash Price	$109.80
Rate for Payer: Cigna of CA HMO/PPO	$195.20
Rate for Payer: Health Smart Auto/Commercial	$146.40
Rate for Payer: LLUH Dept of Risk Management WC	$134.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$183.00

HC GAMMA GLUTAMYL TRANSFERASE

Facility

$20.00

Service Code	CPT 82977
Hospital Charge Code	900910225
Hospital Revenue Code	301
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.00
Rate for Payer: Aetna of CA Government/Medicare	$12.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.00

HC GASTRO PANEL NUCLEIC ACID

Facility

$766.00

Service Code	CPT 87507
Hospital Charge Code	900913644
Hospital Revenue Code	300
Min. Negotiated Rate	$421.30
Max. Negotiated Rate	$612.80
Rate for Payer: Cash Price	$344.70
Rate for Payer: Cigna of CA HMO/PPO	$612.80
Rate for Payer: Health Smart Auto/Commercial	$459.60
Rate for Payer: LLUH Dept of Risk Management WC	$421.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$574.50

HC GASTRO PANEL NUCLEIC ACID

Facility

$644.00

Service Code	CPT 87507
Hospital Charge Code	900913644
Hospital Revenue Code	300
Min. Negotiated Rate	$354.20
Max. Negotiated Rate	$483.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$386.40
Rate for Payer: Aetna of CA Government/Medicare	$386.40
Rate for Payer: Cash Price	$289.80
Rate for Payer: Health Smart Auto/Commercial	$386.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$386.40
Rate for Payer: LLUH Dept of Risk Management WC	$354.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$483.00

HC GENTAMICIN

Facility

$50.00

Service Code	CPT 80170
Hospital Charge Code	900910406
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 GENTAMICIN

Facility

$223.00

Service Code	CPT 80170
Hospital Charge Code	900910406
Hospital Revenue Code	301
Min. Negotiated Rate	$122.65
Max. Negotiated Rate	$178.40
Rate for Payer: Cash Price	$100.35
Rate for Payer: Cigna of CA HMO/PPO	$178.40
Rate for Payer: Health Smart Auto/Commercial	$133.80
Rate for Payer: LLUH Dept of Risk Management WC	$122.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$167.25

HC GLIADIN AB IGA

Facility

$194.00

Service Code	CPT 83516
Hospital Charge Code	900913558
Hospital Revenue Code	302
Min. Negotiated Rate	$106.70
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$87.30
Rate for Payer: Cigna of CA HMO/PPO	$155.20
Rate for Payer: Health Smart Auto/Commercial	$116.40
Rate for Payer: LLUH Dept of Risk Management WC	$106.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$145.50

HC GLIADIN AB IGA

Facility

$44.00

Service Code	CPT 83516
Hospital Charge Code	900913558
Hospital Revenue Code	302
Min. Negotiated Rate	$24.20
Max. Negotiated Rate	$33.00
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: Health Smart Auto/Commercial	$26.40
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 Beech St/Commercial/PHCS	$33.00

HC GLIADIN AB IGG

Facility

$194.00

Service Code	CPT 83516
Hospital Charge Code	900913557
Hospital Revenue Code	302
Min. Negotiated Rate	$106.70
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$87.30
Rate for Payer: Cigna of CA HMO/PPO	$155.20
Rate for Payer: Health Smart Auto/Commercial	$116.40
Rate for Payer: LLUH Dept of Risk Management WC	$106.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$145.50

HC GLIADIN AB IGG

Facility

$44.00

Service Code	CPT 83516
Hospital Charge Code	900913557
Hospital Revenue Code	302
Min. Negotiated Rate	$24.20
Max. Negotiated Rate	$33.00
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: Health Smart Auto/Commercial	$26.40
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 Beech St/Commercial/PHCS	$33.00

HC GLIADIN IGA

Facility

$58.00

Service Code	CPT 83516
Hospital Charge Code	900913658
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 GLIADIN IGA

Facility

$39.00

Service Code	CPT 83516
Hospital Charge Code	900913658
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 GLIADIN IGG

Facility

$39.00

Service Code	CPT 83516
Hospital Charge Code	900913659
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 GLIADIN IGG

Facility

$58.00

Service Code	CPT 83516
Hospital Charge Code	900913659
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 GLUCOSE

Facility

$89.00

Service Code	CPT 82947
Hospital Charge Code	900910498
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 GLUCOSE

Facility

$16.00

Service Code	CPT 82947
Hospital Charge Code	900910498
Hospital Revenue Code	301
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.60
Rate for Payer: Aetna of CA Government/Medicare	$9.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Smart Auto/Commercial	$9.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.60
Rate for Payer: LLUH Dept of Risk Management WC	$8.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.00

HC GLUCOSE ADDITIONAL

Facility

$78.00

Service Code	CPT 82952
Hospital Charge Code	900910444
Hospital Revenue Code	301
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$62.40
Rate for Payer: Cash Price	$35.10
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$58.50

HC GLUCOSE ADDITIONAL

Facility

$16.00

Service Code	CPT 82952
Hospital Charge Code	900910444
Hospital Revenue Code	301
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.60
Rate for Payer: Aetna of CA Government/Medicare	$9.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Smart Auto/Commercial	$9.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.60
Rate for Payer: LLUH Dept of Risk Management WC	$8.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.00

HC GLUCOSE BODY FLUID

Facility

$17.00

Service Code	CPT 82945
Hospital Charge Code	900912249
Hospital Revenue Code	301
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

Know your out-of-pocket cost for care.

All Charges