Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM GASTRIN

Facility

$15.00

Service Code	CPT 82941 90
Hospital Charge Code	900911200
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.00
Rate for Payer: Aetna of CA Government/Medicare	$9.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC SOM GIARDIA LAMBIA AG

Facility

$23.00

Service Code	CPT 87329 90
Hospital Charge Code	900911396
Hospital Revenue Code	306
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$18.40
Rate for Payer: Cash Price	$10.35
Rate for Payer: Cigna of CA HMO/PPO	$18.40
Rate for Payer: Health Smart Auto/Commercial	$13.80
Rate for Payer: LLUH Dept of Risk Management WC	$12.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.25

HC SOM GIARDIA LAMBIA AG

Facility

$23.00

Service Code	CPT 87329 90
Hospital Charge Code	900911396
Hospital Revenue Code	306
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$17.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.80
Rate for Payer: Aetna of CA Government/Medicare	$13.80
Rate for Payer: Cash Price	$10.35
Rate for Payer: Health Smart Auto/Commercial	$13.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.80
Rate for Payer: LLUH Dept of Risk Management WC	$12.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.25

HC SOM GIARDIA LAMBIA AG

Facility

$23.00

Service Code	CPT 87329
Hospital Charge Code	900911396
Hospital Revenue Code	306
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$17.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.80
Rate for Payer: Aetna of CA Government/Medicare	$13.80
Rate for Payer: Cash Price	$10.35
Rate for Payer: Health Smart Auto/Commercial	$13.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.80
Rate for Payer: LLUH Dept of Risk Management WC	$12.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.25

HC SOM GIARDIA LAMBIA AG

Facility

$23.00

Service Code	CPT 87329
Hospital Charge Code	900911396
Hospital Revenue Code	306
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$18.40
Rate for Payer: Cash Price	$10.35
Rate for Payer: Cigna of CA HMO/PPO	$18.40
Rate for Payer: Health Smart Auto/Commercial	$13.80
Rate for Payer: LLUH Dept of Risk Management WC	$12.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.25

HC SOM GLUCAGON

Facility

$38.00

Service Code	CPT 82943
Hospital Charge Code	900911016
Hospital Revenue Code	301
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$28.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.80
Rate for Payer: Aetna of CA Government/Medicare	$22.80
Rate for Payer: Cash Price	$17.10
Rate for Payer: Health Smart Auto/Commercial	$22.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.80
Rate for Payer: LLUH Dept of Risk Management WC	$20.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.50

HC SOM GLUCAGON

Facility

$38.00

Service Code	CPT 82943 90
Hospital Charge Code	900911016
Hospital Revenue Code	301
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$28.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.80
Rate for Payer: Aetna of CA Government/Medicare	$22.80
Rate for Payer: Cash Price	$17.10
Rate for Payer: Health Smart Auto/Commercial	$22.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.80
Rate for Payer: LLUH Dept of Risk Management WC	$20.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.50

HC SOM GLUCAGON

Facility

$38.00

Service Code	CPT 82943 90
Hospital Charge Code	900911016
Hospital Revenue Code	301
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$30.40
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cigna of CA HMO/PPO	$30.40
Rate for Payer: Health Smart Auto/Commercial	$22.80
Rate for Payer: LLUH Dept of Risk Management WC	$20.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.50

HC SOM GLUCAGON

Facility

$38.00

Service Code	CPT 82943
Hospital Charge Code	900911016
Hospital Revenue Code	301
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$30.40
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cigna of CA HMO/PPO	$30.40
Rate for Payer: Health Smart Auto/Commercial	$22.80
Rate for Payer: LLUH Dept of Risk Management WC	$20.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.50

HC SOM GLUCOSE-6-PD SCR

Facility

$22.64

Service Code	CPT 82955
Hospital Charge Code	900911305
Hospital Revenue Code	301
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$18.11
Rate for Payer: Cash Price	$10.19
Rate for Payer: Cigna of CA HMO/PPO	$18.11
Rate for Payer: Health Smart Auto/Commercial	$13.58
Rate for Payer: LLUH Dept of Risk Management WC	$12.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.98

HC SOM GLUCOSE-6-PD SCR

Facility

$22.64

Service Code	CPT 82955
Hospital Charge Code	900911305
Hospital Revenue Code	301
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$16.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.58
Rate for Payer: Aetna of CA Government/Medicare	$13.58
Rate for Payer: Cash Price	$10.19
Rate for Payer: Health Smart Auto/Commercial	$13.58
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.58
Rate for Payer: LLUH Dept of Risk Management WC	$12.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.98

HC SOM GLUCOSE-6-PD SCR

Facility

$22.64

Service Code	CPT 82955 90
Hospital Charge Code	900911305
Hospital Revenue Code	301
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$18.11
Rate for Payer: Cash Price	$10.19
Rate for Payer: Cigna of CA HMO/PPO	$18.11
Rate for Payer: Health Smart Auto/Commercial	$13.58
Rate for Payer: LLUH Dept of Risk Management WC	$12.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.98

HC SOM GLUCOSE-6-PD SCR

Facility

$22.64

Service Code	CPT 82955 90
Hospital Charge Code	900911305
Hospital Revenue Code	301
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$16.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.58
Rate for Payer: Aetna of CA Government/Medicare	$13.58
Rate for Payer: Cash Price	$10.19
Rate for Payer: Health Smart Auto/Commercial	$13.58
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.58
Rate for Payer: LLUH Dept of Risk Management WC	$12.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.98

HC SOM GLUTAMIC ACID DECARBOXYLASE AB

Facility

$27.60

Service Code	CPT 86341
Hospital Charge Code	900911121
Hospital Revenue Code	301
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$22.08
Rate for Payer: Cash Price	$12.42
Rate for Payer: Cigna of CA HMO/PPO	$22.08
Rate for Payer: Health Smart Auto/Commercial	$16.56
Rate for Payer: LLUH Dept of Risk Management WC	$15.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.70

HC SOM GLUTAMIC ACID DECARBOXYLASE AB

Facility

$27.60

Service Code	CPT 86341
Hospital Charge Code	900911121
Hospital Revenue Code	301
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.56
Rate for Payer: Aetna of CA Government/Medicare	$16.56
Rate for Payer: Cash Price	$12.42
Rate for Payer: Health Smart Auto/Commercial	$16.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.56
Rate for Payer: LLUH Dept of Risk Management WC	$15.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.70

HC SOM GLUTAMIC ACID DECARBOXYLASE AB

Facility

$27.60

Service Code	CPT 86341 90
Hospital Charge Code	900911121
Hospital Revenue Code	301
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$22.08
Rate for Payer: Cash Price	$12.42
Rate for Payer: Cigna of CA HMO/PPO	$22.08
Rate for Payer: Health Smart Auto/Commercial	$16.56
Rate for Payer: LLUH Dept of Risk Management WC	$15.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.70

HC SOM GLUTAMIC ACID DECARBOXYLASE AB

Facility

$27.60

Service Code	CPT 86341 90
Hospital Charge Code	900911121
Hospital Revenue Code	301
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$20.70
Rate for Payer: Health Smart Auto/Commercial	$16.56
Rate for Payer: Cash Price	$12.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.56
Rate for Payer: Aetna of CA Government/Medicare	$16.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.56
Rate for Payer: LLUH Dept of Risk Management WC	$15.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.70

HC SOM GROWTH HORMONE

Facility

$12.60

Service Code	CPT 83003 90
Hospital Charge Code	900911488
Hospital Revenue Code	301
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$10.08
Rate for Payer: Cash Price	$5.67
Rate for Payer: Cigna of CA HMO/PPO	$10.08
Rate for Payer: Health Smart Auto/Commercial	$7.56
Rate for Payer: LLUH Dept of Risk Management WC	$6.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.45

HC SOM GROWTH HORMONE

Facility

$12.60

Service Code	CPT 83003 90
Hospital Charge Code	900911488
Hospital Revenue Code	301
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$9.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.56
Rate for Payer: Aetna of CA Government/Medicare	$7.56
Rate for Payer: Cash Price	$5.67
Rate for Payer: Health Smart Auto/Commercial	$7.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.56
Rate for Payer: LLUH Dept of Risk Management WC	$6.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.45

HC SOM GROWTH HORMONE

Facility

$12.60

Service Code	CPT 83003
Hospital Charge Code	900911488
Hospital Revenue Code	301
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$9.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.56
Rate for Payer: Aetna of CA Government/Medicare	$7.56
Rate for Payer: Cash Price	$5.67
Rate for Payer: Health Smart Auto/Commercial	$7.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.56
Rate for Payer: LLUH Dept of Risk Management WC	$6.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.45

HC SOM GROWTH HORMONE

Facility

$12.60

Service Code	CPT 83003
Hospital Charge Code	900911488
Hospital Revenue Code	301
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$10.08
Rate for Payer: Cash Price	$5.67
Rate for Payer: Cigna of CA HMO/PPO	$10.08
Rate for Payer: Health Smart Auto/Commercial	$7.56
Rate for Payer: LLUH Dept of Risk Management WC	$6.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.45

HC SOM HALDOL(HALOPERIDOL) LEVEL

Facility

$60.00

Service Code	CPT 80173
Hospital Charge Code	900911401
Hospital Revenue Code	301
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$48.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna of CA HMO/PPO	$48.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.00

HC SOM HALDOL(HALOPERIDOL) LEVEL

Facility

$60.00

Service Code	CPT 80173
Hospital Charge Code	900911401
Hospital Revenue Code	301
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$36.00
Rate for Payer: Aetna of CA Government/Medicare	$36.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.00

HC SOM HALDOL(HALOPERIDOL) LEVEL

Facility

$60.00

Service Code	CPT 80173 90
Hospital Charge Code	900911401
Hospital Revenue Code	301
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$48.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna of CA HMO/PPO	$48.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.00

HC SOM HALDOL(HALOPERIDOL) LEVEL

Facility

$60.00

Service Code	CPT 80173 90
Hospital Charge Code	900911401
Hospital Revenue Code	301
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$36.00
Rate for Payer: Aetna of CA Government/Medicare	$36.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.00

Know your out-of-pocket cost for care.

All Charges