Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC TROPONIN - I

Facility

$18.00

Service Code	CPT 84484
Hospital Charge Code	900910994
Hospital Revenue Code	301
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.80
Rate for Payer: Aetna of CA Government/Medicare	$10.80
Rate for Payer: Cash Price	$8.10
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.80
Rate for Payer: LLUH Dept of Risk Management WC	$9.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.50

HC TROPONIN - I

Facility

$917.00

Service Code	CPT 84484
Hospital Charge Code	900910994
Hospital Revenue Code	301
Min. Negotiated Rate	$504.35
Max. Negotiated Rate	$733.60
Rate for Payer: Cash Price	$412.65
Rate for Payer: Cigna of CA HMO/PPO	$733.60
Rate for Payer: Health Smart Auto/Commercial	$550.20
Rate for Payer: LLUH Dept of Risk Management WC	$504.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$687.75

HC TROPONIN-T

Facility

$29.00

Service Code	CPT 84484
Hospital Charge Code	900912119
Hospital Revenue Code	301
Min. Negotiated Rate	$15.95
Max. Negotiated Rate	$21.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$17.40
Rate for Payer: Aetna of CA Government/Medicare	$17.40
Rate for Payer: Cash Price	$13.05
Rate for Payer: Health Smart Auto/Commercial	$17.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$17.40
Rate for Payer: LLUH Dept of Risk Management WC	$15.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21.75

HC TROPONIN-T

Facility

$285.00

Service Code	CPT 84484
Hospital Charge Code	900912119
Hospital Revenue Code	301
Min. Negotiated Rate	$156.75
Max. Negotiated Rate	$228.00
Rate for Payer: Cash Price	$128.25
Rate for Payer: Cigna of CA HMO/PPO	$228.00
Rate for Payer: Health Smart Auto/Commercial	$171.00
Rate for Payer: LLUH Dept of Risk Management WC	$156.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$213.75

HC TRYPSIN STOOL

Facility

$406.00

Service Code	CPT 84488
Hospital Charge Code	900910231
Hospital Revenue Code	301
Min. Negotiated Rate	$223.30
Max. Negotiated Rate	$324.80
Rate for Payer: Cash Price	$182.70
Rate for Payer: Cigna of CA HMO/PPO	$324.80
Rate for Payer: Health Smart Auto/Commercial	$243.60
Rate for Payer: LLUH Dept of Risk Management WC	$223.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$304.50

HC TRYPSIN STOOL

Facility

$28.00

Service Code	CPT 84488
Hospital Charge Code	900910231
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 TSH (THYROTROPIN)

Facility

$276.00

Service Code	CPT 84443
Hospital Charge Code	900910829
Hospital Revenue Code	301
Min. Negotiated Rate	$151.80
Max. Negotiated Rate	$220.80
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cigna of CA HMO/PPO	$220.80
Rate for Payer: Health Smart Auto/Commercial	$165.60
Rate for Payer: LLUH Dept of Risk Management WC	$151.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$207.00

HC TSH (THYROTROPIN)

Facility

$28.00

Service Code	CPT 84443
Hospital Charge Code	900910829
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 TTG IGA

Facility

$58.00

Service Code	CPT 83516
Hospital Charge Code	900913669
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 TTG IGA

Facility

$39.00

Service Code	CPT 83516
Hospital Charge Code	900913669
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 TTG IGG

Facility

$39.00

Service Code	CPT 83516
Hospital Charge Code	900913670
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 TTG IGG

Facility

$58.00

Service Code	CPT 83516
Hospital Charge Code	900913670
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 U1RNP AUTO AB

Facility

$162.00

Service Code	CPT 86235
Hospital Charge Code	900913524
Hospital Revenue Code	302
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$129.60
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cigna of CA HMO/PPO	$129.60
Rate for Payer: Health Smart Auto/Commercial	$97.20
Rate for Payer: LLUH Dept of Risk Management WC	$89.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$121.50

HC U1RNP AUTO AB

Facility

$28.00

Service Code	CPT 86235
Hospital Charge Code	900913524
Hospital Revenue Code	302
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 ULTRASOUND RETROPERITONEAL COMPLETE

Facility

$2,162.00

Service Code	CPT 76770
Hospital Charge Code	906601156
Hospital Revenue Code	402
Min. Negotiated Rate	$1,189.10
Max. Negotiated Rate	$1,729.60
Rate for Payer: Cash Price	$972.90
Rate for Payer: Cigna of CA HMO/PPO	$1,729.60
Rate for Payer: Health Smart Auto/Commercial	$1,297.20
Rate for Payer: LLUH Dept of Risk Management WC	$1,189.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,621.50

HC ULTRASOUND RETROPERITONEAL COMPLETE

Facility

$2,162.00

Service Code	CPT 76770 TC
Hospital Charge Code	906601156
Hospital Revenue Code	402
Min. Negotiated Rate	$1,189.10
Max. Negotiated Rate	$1,729.60
Rate for Payer: Cash Price	$972.90
Rate for Payer: Cigna of CA HMO/PPO	$1,729.60
Rate for Payer: Health Smart Auto/Commercial	$1,297.20
Rate for Payer: LLUH Dept of Risk Management WC	$1,189.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,621.50

HC ULTRASOUND RETROPERITONEAL COMPLETE

Facility

$2,162.00

Service Code	CPT 76770 TC
Hospital Charge Code	906601156
Hospital Revenue Code	402
Min. Negotiated Rate	$1,189.10
Max. Negotiated Rate	$1,621.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,297.20
Rate for Payer: Aetna of CA Government/Medicare	$1,297.20
Rate for Payer: Cash Price	$972.90
Rate for Payer: Health Smart Auto/Commercial	$1,297.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,297.20
Rate for Payer: LLUH Dept of Risk Management WC	$1,189.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,621.50

HC ULTRASOUND RETROPERITONEAL COMPLETE

Facility

$2,162.00

Service Code	CPT 76770
Hospital Charge Code	906601156
Hospital Revenue Code	402
Min. Negotiated Rate	$1,189.10
Max. Negotiated Rate	$1,621.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,297.20
Rate for Payer: Aetna of CA Government/Medicare	$1,297.20
Rate for Payer: Cash Price	$972.90
Rate for Payer: Health Smart Auto/Commercial	$1,297.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,297.20
Rate for Payer: LLUH Dept of Risk Management WC	$1,189.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,621.50

HC UREA NITROGEN, UR

Facility

$16.00

Service Code	CPT 84540
Hospital Charge Code	900910460
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 UREA NITROGEN, UR

Facility

$194.00

Service Code	CPT 84540
Hospital Charge Code	900910460
Hospital Revenue Code	301
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 URIC ACID

Facility

$112.00

Service Code	CPT 84550
Hospital Charge Code	900910254
Hospital Revenue Code	301
Min. Negotiated Rate	$61.60
Max. Negotiated Rate	$89.60
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cigna of CA HMO/PPO	$89.60
Rate for Payer: Health Smart Auto/Commercial	$67.20
Rate for Payer: LLUH Dept of Risk Management WC	$61.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$84.00

HC URIC ACID

Facility

$17.00

Service Code	CPT 84550
Hospital Charge Code	900910254
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

HC URIC ACID BODY FLUID

Facility

$17.00

Service Code	CPT 84560
Hospital Charge Code	900912248
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

HC URIC ACID BODY FLUID

Facility

$25.00

Service Code	CPT 84560
Hospital Charge Code	900912248
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$20.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Cigna of CA HMO/PPO	$20.00
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.75

HC URIC ACID URINE

Facility

$112.00

Service Code	CPT 84560
Hospital Charge Code	900910216
Hospital Revenue Code	301
Min. Negotiated Rate	$61.60
Max. Negotiated Rate	$89.60
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cigna of CA HMO/PPO	$89.60
Rate for Payer: Health Smart Auto/Commercial	$67.20
Rate for Payer: LLUH Dept of Risk Management WC	$61.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$84.00

Know your out-of-pocket cost for care.

All Charges