Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC GLUCOSE BODY FLUID

Facility

$32.00

Service Code	CPT 82945
Hospital Charge Code	900912249
Hospital Revenue Code	301
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$25.60
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna of CA HMO/PPO	$25.60
Rate for Payer: Health Smart Auto/Commercial	$19.20
Rate for Payer: LLUH Dept of Risk Management WC	$17.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.00

HC GLUCOSE CSF

Facility

$32.00

Service Code	CPT 82945
Hospital Charge Code	900910305
Hospital Revenue Code	301
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$25.60
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna of CA HMO/PPO	$25.60
Rate for Payer: Health Smart Auto/Commercial	$19.20
Rate for Payer: LLUH Dept of Risk Management WC	$17.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.00

HC GLUCOSE CSF

Facility

$11.00

Service Code	CPT 82945
Hospital Charge Code	900910305
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 GLUCOSE FASTING

Facility

$16.00

Service Code	CPT 82947
Hospital Charge Code	900910306
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 FASTING

Facility

$89.00

Service Code	CPT 82947
Hospital Charge Code	900910306
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 LOADING 1 HR

Facility

$16.00

Service Code	CPT 82950
Hospital Charge Code	900910314
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 LOADING 1 HR

Facility

$95.00

Service Code	CPT 82950
Hospital Charge Code	900910314
Hospital Revenue Code	301
Min. Negotiated Rate	$52.25
Max. Negotiated Rate	$76.00
Rate for Payer: Cash Price	$42.75
Rate for Payer: Cigna of CA HMO/PPO	$76.00
Rate for Payer: Health Smart Auto/Commercial	$57.00
Rate for Payer: LLUH Dept of Risk Management WC	$52.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$71.25

HC GLUCOSE RANDOM

Facility

$16.00

Service Code	CPT 82947
Hospital Charge Code	900910307
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 RANDOM

Facility

$89.00

Service Code	CPT 82947
Hospital Charge Code	900910307
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 TESTING POC

Facility

$124.00

Service Code	CPT 82962
Hospital Charge Code	900910468
Hospital Revenue Code	301
Min. Negotiated Rate	$68.20
Max. Negotiated Rate	$99.20
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cigna of CA HMO/PPO	$99.20
Rate for Payer: Health Smart Auto/Commercial	$74.40
Rate for Payer: LLUH Dept of Risk Management WC	$68.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$93.00

HC GLUCOSE TESTING POC

Facility

$124.00

Service Code	CPT 82962
Hospital Charge Code	900910468
Hospital Revenue Code	300
Min. Negotiated Rate	$68.20
Max. Negotiated Rate	$99.20
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cigna of CA HMO/PPO	$99.20
Rate for Payer: Health Smart Auto/Commercial	$74.40
Rate for Payer: LLUH Dept of Risk Management WC	$68.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$93.00

HC GLUCOSE TESTING POC

Facility

$12.00

Service Code	CPT 82962
Hospital Charge Code	900910468
Hospital Revenue Code	301
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 GLUCOSE TESTING POC

Facility

$12.00

Service Code	CPT 82962
Hospital Charge Code	900910468
Hospital Revenue Code	300
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 GLUCOSE TOLERANCE TEST 2 HR

Facility

$204.00

Service Code	CPT 82951
Hospital Charge Code	900910208
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 GLUCOSE TOLERANCE TEST 2 HR

Facility

$49.00

Service Code	CPT 82951
Hospital Charge Code	900910208
Hospital Revenue Code	301
Min. Negotiated Rate	$26.95
Max. Negotiated Rate	$36.75
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: Health Smart Auto/Commercial	$29.40
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 Beech St/Commercial/PHCS	$36.75

HC GLUCOSE TOLERANCE TEST 3 HR

Facility

$204.00

Service Code	CPT 82951
Hospital Charge Code	900910308
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 GLUCOSE TOLERANCE TEST 3 HR

Facility

$49.00

Service Code	CPT 82951
Hospital Charge Code	900910308
Hospital Revenue Code	301
Min. Negotiated Rate	$26.95
Max. Negotiated Rate	$36.75
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: Health Smart Auto/Commercial	$29.40
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 Beech St/Commercial/PHCS	$36.75

HC GLUCOSE URINE

Facility

$49.00

Service Code	CPT 82945
Hospital Charge Code	900910311
Hospital Revenue Code	301
Min. Negotiated Rate	$26.95
Max. Negotiated Rate	$39.20
Rate for Payer: Cash Price	$22.05
Rate for Payer: Cigna of CA HMO/PPO	$39.20
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: LLUH Dept of Risk Management WC	$26.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.75

HC GLUCOSE URINE

Facility

$16.00

Service Code	CPT 82945
Hospital Charge Code	900910311
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 GRAM POSITIVE SENSITIVITY MIC

Facility

$32.00

Service Code	CPT 87186
Hospital Charge Code	900912491
Hospital Revenue Code	300
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$25.60
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna of CA HMO/PPO	$25.60
Rate for Payer: Health Smart Auto/Commercial	$19.20
Rate for Payer: LLUH Dept of Risk Management WC	$17.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.00

HC GRAM POSITIVE SENSITIVITY MIC

Facility

$22.00

Service Code	CPT 87186
Hospital Charge Code	900912491
Hospital Revenue Code	300
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$16.50
Rate for Payer: Health Smart Auto/Commercial	$13.20
Rate for Payer: Cash Price	$9.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.20
Rate for Payer: Aetna of CA Government/Medicare	$13.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.20
Rate for Payer: LLUH Dept of Risk Management WC	$12.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.50

HC GRAM STAIN

Facility

$160.00

Service Code	CPT 87205
Hospital Charge Code	900911705
Hospital Revenue Code	306
Min. Negotiated Rate	$88.00
Max. Negotiated Rate	$128.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna of CA HMO/PPO	$128.00
Rate for Payer: Health Smart Auto/Commercial	$96.00
Rate for Payer: LLUH Dept of Risk Management WC	$88.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$120.00

HC GRAM STAIN

Facility

$13.00

Service Code	CPT 87205
Hospital Charge Code	900911705
Hospital Revenue Code	306
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$9.75
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: Health Smart Auto/Commercial	$7.80
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 Beech St/Commercial/PHCS	$9.75

HC GROUP PSYCHOTHERAPY-MOTIVATION

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804018
Hospital Revenue Code	912
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$725.00
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	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cigna of CA HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Heritage Provider Network Commercial	$472.00
Rate for Payer: Heritage Provider Network Senior	$472.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$463.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$522.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Magellan Commercial	$637.00
Rate for Payer: Managed Health Network (MHN) Commercial	$682.00
Rate for Payer: Managed Health Network (MHN) Medicare	$111.37
Rate for Payer: Mary Free Bed Workers' Compensation	$41.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75
Rate for Payer: US Behavioral Health Commercial/Medicare	$498.68

HC GROUP PSYCHOTHERAPY-MOTIVATION

Facility

$325.00

Service Code	CPT G0411
Hospital Charge Code	907804018
Hospital Revenue Code	915
Min. Negotiated Rate	$178.75
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$195.00
Rate for Payer: Aetna of CA Government/Medicare	$195.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Health Smart Auto/Commercial	$195.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$195.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

Know your out-of-pocket cost for care.

All Charges