Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC TROPONIN - I

Facility

$56.00

Service Code	CPT 84484
Hospital Charge Code	900910994
Hospital Revenue Code	301
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$44.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$33.60
Rate for Payer: Aetna of CA Government/Medicare	$33.60
Rate for Payer: Cash Price	$25.20
Rate for Payer: Cash Price	$25.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$44.80
Rate for Payer: Health Smart Auto/Commercial	$33.60
Rate for Payer: Intervalley Health Plan Commercial	$12.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$33.60
Rate for Payer: LLUH Dept of Risk Management WC	$30.80
Rate for Payer: Multiplan Commercial	$42.00

HC TROPONIN - I

Facility

$1,014.00

Service Code	CPT 84484
Hospital Charge Code	900910994
Hospital Revenue Code	301
Min. Negotiated Rate	$557.70
Max. Negotiated Rate	$811.20
Rate for Payer: Cash Price	$456.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$811.20
Rate for Payer: Health Smart Auto/Commercial	$608.40
Rate for Payer: LLUH Dept of Risk Management WC	$557.70
Rate for Payer: Multiplan Commercial	$760.50

HC TROPONIN-T

Facility

$315.00

Service Code	CPT 84484
Hospital Charge Code	900912119
Hospital Revenue Code	301
Min. Negotiated Rate	$173.25
Max. Negotiated Rate	$252.00
Rate for Payer: Cash Price	$141.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$252.00
Rate for Payer: Health Smart Auto/Commercial	$189.00
Rate for Payer: LLUH Dept of Risk Management WC	$173.25
Rate for Payer: Multiplan Commercial	$236.25

HC TROPONIN-T

Facility

$78.00

Service Code	CPT 84484
Hospital Charge Code	900912119
Hospital Revenue Code	301
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$62.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$46.80
Rate for Payer: Aetna of CA Government/Medicare	$46.80
Rate for Payer: Cash Price	$35.10
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: Intervalley Health Plan Commercial	$12.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$46.80
Rate for Payer: LLUH Dept of Risk Management WC	$42.90
Rate for Payer: Multiplan Commercial	$58.50

HC TRYPSIN STOOL

Facility

$31.00

Service Code	CPT 84488
Hospital Charge Code	900910231
Hospital Revenue Code	301
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$24.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.60
Rate for Payer: Aetna of CA Government/Medicare	$18.60
Rate for Payer: Cash Price	$13.95
Rate for Payer: Cash Price	$13.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$24.80
Rate for Payer: Health Smart Auto/Commercial	$18.60
Rate for Payer: Intervalley Health Plan Commercial	$7.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.60
Rate for Payer: LLUH Dept of Risk Management WC	$17.05
Rate for Payer: Multiplan Commercial	$23.25

HC TRYPSIN STOOL

Facility

$449.00

Service Code	CPT 84488
Hospital Charge Code	900910231
Hospital Revenue Code	301
Min. Negotiated Rate	$246.95
Max. Negotiated Rate	$359.20
Rate for Payer: Cash Price	$202.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$359.20
Rate for Payer: Health Smart Auto/Commercial	$269.40
Rate for Payer: LLUH Dept of Risk Management WC	$246.95
Rate for Payer: Multiplan Commercial	$336.75

HC TSH (THYROTROPIN)

Facility

$305.00

Service Code	CPT 84443
Hospital Charge Code	900910829
Hospital Revenue Code	301
Min. Negotiated Rate	$167.75
Max. Negotiated Rate	$244.00
Rate for Payer: Cash Price	$137.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$244.00
Rate for Payer: Health Smart Auto/Commercial	$183.00
Rate for Payer: LLUH Dept of Risk Management WC	$167.75
Rate for Payer: Multiplan Commercial	$228.75

HC TSH (THYROTROPIN)

Facility

$142.63

Service Code	CPT 84443
Hospital Charge Code	900910829
Hospital Revenue Code	301
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$114.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$85.58
Rate for Payer: Aetna of CA Government/Medicare	$85.58
Rate for Payer: Cash Price	$64.18
Rate for Payer: Cash Price	$64.18
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$114.10
Rate for Payer: Health Smart Auto/Commercial	$85.58
Rate for Payer: Intervalley Health Plan Commercial	$16.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$85.58
Rate for Payer: LLUH Dept of Risk Management WC	$78.45
Rate for Payer: Multiplan Commercial	$106.97

HC TTG IGA

Facility

$49.00

Service Code	CPT 83516
Hospital Charge Code	900913669
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 TTG IGA

Facility

$64.00

Service Code	CPT 83516
Hospital Charge Code	900913669
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 TTG IGG

Facility

$64.00

Service Code	CPT 83516
Hospital Charge Code	900913670
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 TTG IGG

Facility

$49.00

Service Code	CPT 83516
Hospital Charge Code	900913670
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 U1RNP AUTO AB

Facility

$44.00

Service Code	CPT 86235
Hospital Charge Code	900913524
Hospital Revenue Code	302
Min. Negotiated Rate	$17.93
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	$17.93
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 U1RNP AUTO AB

Facility

$171.00

Service Code	CPT 86235
Hospital Charge Code	900913524
Hospital Revenue Code	302
Min. Negotiated Rate	$94.05
Max. Negotiated Rate	$136.80
Rate for Payer: Cash Price	$76.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$136.80
Rate for Payer: Health Smart Auto/Commercial	$102.60
Rate for Payer: LLUH Dept of Risk Management WC	$94.05
Rate for Payer: Multiplan Commercial	$128.25

HC ULTRASOUND RETROPERITONEAL COMPLETE

Facility

$2,430.00

Service Code	CPT 76770
Hospital Charge Code	906601156
Hospital Revenue Code	402
Min. Negotiated Rate	$1,336.50
Max. Negotiated Rate	$1,944.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,458.00
Rate for Payer: Aetna of CA Government/Medicare	$1,458.00
Rate for Payer: Cash Price	$1,093.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,944.00
Rate for Payer: Health Smart Auto/Commercial	$1,458.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,458.00
Rate for Payer: LLUH Dept of Risk Management WC	$1,336.50
Rate for Payer: Multiplan Commercial	$1,822.50

HC ULTRASOUND RETROPERITONEAL COMPLETE

Facility

$2,430.00

Service Code	CPT 76770
Hospital Charge Code	906601156
Hospital Revenue Code	402
Min. Negotiated Rate	$1,336.50
Max. Negotiated Rate	$1,944.00
Rate for Payer: Cash Price	$1,093.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,944.00
Rate for Payer: Health Smart Auto/Commercial	$1,458.00
Rate for Payer: LLUH Dept of Risk Management WC	$1,336.50
Rate for Payer: Multiplan Commercial	$1,822.50

HC UREA NITROGEN, UR

Facility

$215.00

Service Code	CPT 84540
Hospital Charge Code	900910460
Hospital Revenue Code	301
Min. Negotiated Rate	$118.25
Max. Negotiated Rate	$172.00
Rate for Payer: Cash Price	$96.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$172.00
Rate for Payer: Health Smart Auto/Commercial	$129.00
Rate for Payer: LLUH Dept of Risk Management WC	$118.25
Rate for Payer: Multiplan Commercial	$161.25

HC UREA NITROGEN, UR

Facility

$26.00

Service Code	CPT 84540
Hospital Charge Code	900910460
Hospital Revenue Code	301
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$20.80
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: Cash Price	$11.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$20.80
Rate for Payer: Health Smart Auto/Commercial	$15.60
Rate for Payer: Intervalley Health Plan Commercial	$5.56
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 Commercial	$19.50

HC URIC ACID

Facility

$48.00

Service Code	CPT 84550
Hospital Charge Code	900910254
Hospital Revenue Code	301
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$38.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$28.80
Rate for Payer: Aetna of CA Government/Medicare	$28.80
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$38.40
Rate for Payer: Health Smart Auto/Commercial	$28.80
Rate for Payer: Intervalley Health Plan Commercial	$4.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$28.80
Rate for Payer: LLUH Dept of Risk Management WC	$26.40
Rate for Payer: Multiplan Commercial	$36.00

HC URIC ACID

Facility

$99.20

Service Code	CPT 84550
Hospital Charge Code	900910254
Hospital Revenue Code	301
Min. Negotiated Rate	$54.56
Max. Negotiated Rate	$79.36
Rate for Payer: Cash Price	$44.64
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$79.36
Rate for Payer: Health Smart Auto/Commercial	$59.52
Rate for Payer: LLUH Dept of Risk Management WC	$54.56
Rate for Payer: Multiplan Commercial	$74.40

HC URIC ACID BODY FLUID

Facility

$27.00

Service Code	CPT 84560
Hospital Charge Code	900912248
Hospital Revenue Code	301
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.20
Rate for Payer: Aetna of CA Government/Medicare	$16.20
Rate for Payer: Cash Price	$12.15
Rate for Payer: Cash Price	$12.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$21.60
Rate for Payer: Health Smart Auto/Commercial	$16.20
Rate for Payer: Intervalley Health Plan Commercial	$5.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.20
Rate for Payer: LLUH Dept of Risk Management WC	$14.85
Rate for Payer: Multiplan Commercial	$20.25

HC URIC ACID BODY FLUID

Facility

$28.00

Service Code	CPT 84560
Hospital Charge Code	900912248
Hospital Revenue Code	301
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$22.40
Rate for Payer: Cash Price	$12.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.40
Rate for Payer: Health Smart Auto/Commercial	$16.80
Rate for Payer: LLUH Dept of Risk Management WC	$15.40
Rate for Payer: Multiplan Commercial	$21.00

HC URIC ACID URINE

Facility

$124.00

Service Code	CPT 84560
Hospital Charge Code	900910216
Hospital Revenue Code	301
Min. Negotiated Rate	$68.20
Max. Negotiated Rate	$99.20
Rate for Payer: Cash Price	$55.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$93.00

HC URIC ACID URINE

Facility

$20.00

Service Code	CPT 84560
Hospital Charge Code	900910216
Hospital Revenue Code	301
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$16.00
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: Cash Price	$9.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: Intervalley Health Plan Commercial	$5.08
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 Commercial	$15.00

HC URINE CHEMISTRY SCREEN

Facility

$87.00

Service Code	CPT 81003
Hospital Charge Code	900910180
Hospital Revenue Code	307
Min. Negotiated Rate	$47.85
Max. Negotiated Rate	$69.60
Rate for Payer: Cash Price	$39.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$69.60
Rate for Payer: Health Smart Auto/Commercial	$52.20
Rate for Payer: LLUH Dept of Risk Management WC	$47.85
Rate for Payer: Multiplan Commercial	$65.25

Know your out-of-pocket cost for care.

All Charges