Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC CBC W WO DIFFERENTIAL INDIVIDUAL

Facility

$52.00

Service Code	CPT 85027
Hospital Charge Code	900912019
Hospital Revenue Code	305
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$41.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$31.20
Rate for Payer: Aetna of CA Government/Medicare	$31.20
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cash Price	$23.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$41.60
Rate for Payer: Health Smart Auto/Commercial	$31.20
Rate for Payer: Intervalley Health Plan Commercial	$6.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$31.20
Rate for Payer: LLUH Dept of Risk Management WC	$28.60
Rate for Payer: Multiplan Commercial	$39.00

HC C DIFFICILE TOXIN A/B ASSAY

Facility

$96.00

Service Code	CPT 87324
Hospital Charge Code	900911750
Hospital Revenue Code	306
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$76.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$57.60
Rate for Payer: Aetna of CA Government/Medicare	$57.60
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$76.80
Rate for Payer: Health Smart Auto/Commercial	$57.60
Rate for Payer: Intervalley Health Plan Commercial	$11.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$57.60
Rate for Payer: LLUH Dept of Risk Management WC	$52.80
Rate for Payer: Multiplan Commercial	$72.00

HC C DIFFICILE TOXIN A/B ASSAY

Facility

$288.00

Service Code	CPT 87324
Hospital Charge Code	900911750
Hospital Revenue Code	306
Min. Negotiated Rate	$158.40
Max. Negotiated Rate	$230.40
Rate for Payer: Cash Price	$129.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$230.40
Rate for Payer: Health Smart Auto/Commercial	$172.80
Rate for Payer: LLUH Dept of Risk Management WC	$158.40
Rate for Payer: Multiplan Commercial	$216.00

HC CEFINASE

Facility

$24.00

Service Code	CPT 87185
Hospital Charge Code	900912424
Hospital Revenue Code	306
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$19.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.40
Rate for Payer: Aetna of CA Government/Medicare	$14.40
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$10.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.20
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: Intervalley Health Plan Commercial	$4.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Commercial	$18.00

HC CEFINASE

Facility

$103.00

Service Code	CPT 87185
Hospital Charge Code	900912424
Hospital Revenue Code	306
Min. Negotiated Rate	$56.65
Max. Negotiated Rate	$82.40
Rate for Payer: Cash Price	$46.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$82.40
Rate for Payer: Health Smart Auto/Commercial	$61.80
Rate for Payer: LLUH Dept of Risk Management WC	$56.65
Rate for Payer: Multiplan Commercial	$77.25

HC CELL COUNT & DIFF

Facility

$286.00

Service Code	CPT 89051
Hospital Charge Code	900910124
Hospital Revenue Code	300
Min. Negotiated Rate	$157.30
Max. Negotiated Rate	$228.80
Rate for Payer: Cash Price	$128.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$228.80
Rate for Payer: Health Smart Auto/Commercial	$171.60
Rate for Payer: LLUH Dept of Risk Management WC	$157.30
Rate for Payer: Multiplan Commercial	$214.50

HC CELL COUNT & DIFF

Facility

$59.00

Service Code	CPT 89051
Hospital Charge Code	900910124
Hospital Revenue Code	300
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$47.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$35.40
Rate for Payer: Aetna of CA Government/Medicare	$35.40
Rate for Payer: Cash Price	$26.55
Rate for Payer: Cash Price	$26.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$47.20
Rate for Payer: Health Smart Auto/Commercial	$35.40
Rate for Payer: Intervalley Health Plan Commercial	$5.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$35.40
Rate for Payer: LLUH Dept of Risk Management WC	$32.45
Rate for Payer: Multiplan Commercial	$44.25

HC CELL EXPANSION

Facility

$384.00

Service Code	CPT 88233
Hospital Charge Code	900918001
Hospital Revenue Code	310
Min. Negotiated Rate	$211.20
Max. Negotiated Rate	$307.20
Rate for Payer: Cash Price	$172.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$307.20
Rate for Payer: Health Smart Auto/Commercial	$230.40
Rate for Payer: LLUH Dept of Risk Management WC	$211.20
Rate for Payer: Multiplan Commercial	$288.00

HC CELL EXPANSION

Facility

$346.00

Service Code	CPT 88233
Hospital Charge Code	900918001
Hospital Revenue Code	310
Min. Negotiated Rate	$140.73
Max. Negotiated Rate	$276.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$207.60
Rate for Payer: Aetna of CA Government/Medicare	$207.60
Rate for Payer: Cash Price	$155.70
Rate for Payer: Cash Price	$155.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$276.80
Rate for Payer: Health Smart Auto/Commercial	$207.60
Rate for Payer: Intervalley Health Plan Commercial	$140.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$207.60
Rate for Payer: LLUH Dept of Risk Management WC	$190.30
Rate for Payer: Multiplan Commercial	$259.50

HC CELL MORPHOLOGY (VISUAL)

Facility

$124.00

Service Code	CPT 85007
Hospital Charge Code	900910073
Hospital Revenue Code	305
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 CELL MORPHOLOGY (VISUAL)

Facility

$30.29

Service Code	CPT 85007
Hospital Charge Code	900910073
Hospital Revenue Code	305
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$24.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.17
Rate for Payer: Aetna of CA Government/Medicare	$18.17
Rate for Payer: Cash Price	$13.63
Rate for Payer: Cash Price	$13.63
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$24.23
Rate for Payer: Health Smart Auto/Commercial	$18.17
Rate for Payer: Intervalley Health Plan Commercial	$3.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.17
Rate for Payer: LLUH Dept of Risk Management WC	$16.66
Rate for Payer: Multiplan Commercial	$22.72

HC CELL MORPHOLOGY VISUAL INDIVIDUAL

Facility

$24.00

Service Code	CPT 85007
Hospital Charge Code	900912021
Hospital Revenue Code	305
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$19.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.40
Rate for Payer: Aetna of CA Government/Medicare	$14.40
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$10.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.20
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: Intervalley Health Plan Commercial	$3.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Commercial	$18.00

HC CELL MORPHOLOGY VISUAL INDIVIDUAL

Facility

$124.00

Service Code	CPT 85007
Hospital Charge Code	900912021
Hospital Revenue Code	305
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 CENTROMERE AB

Facility

$186.00

Service Code	CPT 86255
Hospital Charge Code	900913527
Hospital Revenue Code	302
Min. Negotiated Rate	$102.30
Max. Negotiated Rate	$148.80
Rate for Payer: Cash Price	$83.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$148.80
Rate for Payer: Health Smart Auto/Commercial	$111.60
Rate for Payer: LLUH Dept of Risk Management WC	$102.30
Rate for Payer: Multiplan Commercial	$139.50

HC CENTROMERE AB

Facility

$64.00

Service Code	CPT 86255
Hospital Charge Code	900913527
Hospital Revenue Code	302
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$51.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$38.40
Rate for Payer: Aetna of CA Government/Medicare	$38.40
Rate for Payer: Cash Price	$28.80
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: Intervalley Health Plan Commercial	$12.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$38.40
Rate for Payer: LLUH Dept of Risk Management WC	$35.20
Rate for Payer: Multiplan Commercial	$48.00

HC CERULOPLASMIN

Facility

$153.00

Service Code	CPT 82390
Hospital Charge Code	900910839
Hospital Revenue Code	301
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$122.40
Rate for Payer: Cash Price	$68.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$122.40
Rate for Payer: Health Smart Auto/Commercial	$91.80
Rate for Payer: LLUH Dept of Risk Management WC	$84.15
Rate for Payer: Multiplan Commercial	$114.75

HC CERULOPLASMIN

Facility

$82.00

Service Code	CPT 82390
Hospital Charge Code	900910839
Hospital Revenue Code	301
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$65.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$49.20
Rate for Payer: Aetna of CA Government/Medicare	$49.20
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cash Price	$36.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$65.60
Rate for Payer: Health Smart Auto/Commercial	$49.20
Rate for Payer: Intervalley Health Plan Commercial	$10.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$49.20
Rate for Payer: LLUH Dept of Risk Management WC	$45.10
Rate for Payer: Multiplan Commercial	$61.50

HC CHEST 1VIEW

Facility

$623.00

Hospital Charge Code	909001155
Hospital Revenue Code	320
Min. Negotiated Rate	$342.65
Max. Negotiated Rate	$498.40
Rate for Payer: Cash Price	$280.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$498.40
Rate for Payer: Health Smart Auto/Commercial	$373.80
Rate for Payer: LLUH Dept of Risk Management WC	$342.65
Rate for Payer: Multiplan Commercial	$467.25

HC CHEST 1VIEW

Facility

$623.00

Hospital Charge Code	909001155
Hospital Revenue Code	320
Min. Negotiated Rate	$342.65
Max. Negotiated Rate	$498.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$373.80
Rate for Payer: Aetna of CA Government/Medicare	$373.80
Rate for Payer: Cash Price	$280.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$498.40
Rate for Payer: Health Smart Auto/Commercial	$373.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$373.80
Rate for Payer: LLUH Dept of Risk Management WC	$342.65
Rate for Payer: Multiplan Commercial	$467.25

HC CHEST 3VIEW

Facility

$623.00

Hospital Charge Code	909001152
Hospital Revenue Code	320
Min. Negotiated Rate	$342.65
Max. Negotiated Rate	$498.40
Rate for Payer: Cash Price	$280.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$498.40
Rate for Payer: Health Smart Auto/Commercial	$373.80
Rate for Payer: LLUH Dept of Risk Management WC	$342.65
Rate for Payer: Multiplan Commercial	$467.25

HC CHEST 3VIEW

Facility

$623.00

Hospital Charge Code	909001152
Hospital Revenue Code	320
Min. Negotiated Rate	$342.65
Max. Negotiated Rate	$498.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$373.80
Rate for Payer: Aetna of CA Government/Medicare	$373.80
Rate for Payer: Cash Price	$280.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$498.40
Rate for Payer: Health Smart Auto/Commercial	$373.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$373.80
Rate for Payer: LLUH Dept of Risk Management WC	$342.65
Rate for Payer: Multiplan Commercial	$467.25

HC CHLAMYDIA AMPLIFICATION

Facility

$115.05

Service Code	CPT 87491
Hospital Charge Code	900912304
Hospital Revenue Code	301
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$92.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$69.03
Rate for Payer: Aetna of CA Government/Medicare	$69.03
Rate for Payer: Cash Price	$51.77
Rate for Payer: Cash Price	$51.77
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$92.04
Rate for Payer: Health Smart Auto/Commercial	$69.03
Rate for Payer: Intervalley Health Plan Commercial	$35.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$69.03
Rate for Payer: LLUH Dept of Risk Management WC	$63.28
Rate for Payer: Multiplan Commercial	$86.29

HC CHLAMYDIA AMPLIFICATION

Facility

$348.00

Service Code	CPT 87491
Hospital Charge Code	900912304
Hospital Revenue Code	301
Min. Negotiated Rate	$191.40
Max. Negotiated Rate	$278.40
Rate for Payer: Cash Price	$156.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$278.40
Rate for Payer: Health Smart Auto/Commercial	$208.80
Rate for Payer: LLUH Dept of Risk Management WC	$191.40
Rate for Payer: Multiplan Commercial	$261.00

HC CHLAMYDIA PNEU CULTR SOURCE SO

Facility

$21.09

Service Code	CPT 87140
Hospital Charge Code	900914083
Hospital Revenue Code	306
Min. Negotiated Rate	$11.60
Max. Negotiated Rate	$16.87
Rate for Payer: Cash Price	$9.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.87
Rate for Payer: Health Smart Auto/Commercial	$12.65
Rate for Payer: LLUH Dept of Risk Management WC	$11.60
Rate for Payer: Multiplan Commercial	$15.82

HC CHLAMYDIA PNEU CULTR SOURCE SO

Facility

$21.09

Service Code	CPT 87140
Hospital Charge Code	900914083
Hospital Revenue Code	306
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$16.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.65
Rate for Payer: Aetna of CA Government/Medicare	$12.65
Rate for Payer: Cash Price	$9.49
Rate for Payer: Cash Price	$9.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.87
Rate for Payer: Health Smart Auto/Commercial	$12.65
Rate for Payer: Intervalley Health Plan Commercial	$5.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.65
Rate for Payer: LLUH Dept of Risk Management WC	$11.60
Rate for Payer: Multiplan Commercial	$15.82

Know your out-of-pocket cost for care.

All Charges