Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC CULTURE URINE ID

Facility

$62.00

Service Code	CPT 87088
Hospital Charge Code	900911556
Hospital Revenue Code	306
Min. Negotiated Rate	$8.09
Max. Negotiated Rate	$49.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$37.20
Rate for Payer: Aetna of CA Government/Medicare	$37.20
Rate for Payer: Cash Price	$27.90
Rate for Payer: Cash Price	$27.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$49.60
Rate for Payer: Health Smart Auto/Commercial	$37.20
Rate for Payer: Intervalley Health Plan Commercial	$8.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$37.20
Rate for Payer: LLUH Dept of Risk Management WC	$34.10
Rate for Payer: Multiplan Commercial	$46.50

HC CULTURE URINE ID

Facility

$200.00

Service Code	CPT 87088
Hospital Charge Code	900911556
Hospital Revenue Code	306
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$160.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$160.00
Rate for Payer: Health Smart Auto/Commercial	$120.00
Rate for Payer: LLUH Dept of Risk Management WC	$110.00
Rate for Payer: Multiplan Commercial	$150.00

HC CULTURE UROGENITAL

Facility

$390.00

Service Code	CPT 87070
Hospital Charge Code	900911519
Hospital Revenue Code	306
Min. Negotiated Rate	$214.50
Max. Negotiated Rate	$312.00
Rate for Payer: Cash Price	$175.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$312.00
Rate for Payer: Health Smart Auto/Commercial	$234.00
Rate for Payer: LLUH Dept of Risk Management WC	$214.50
Rate for Payer: Multiplan Commercial	$292.50

HC CULTURE UROGENITAL

Facility

$84.00

Service Code	CPT 87070
Hospital Charge Code	900911519
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$67.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$50.40
Rate for Payer: Aetna of CA Government/Medicare	$50.40
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cash Price	$37.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$67.20
Rate for Payer: Health Smart Auto/Commercial	$50.40
Rate for Payer: Intervalley Health Plan Commercial	$8.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$50.40
Rate for Payer: LLUH Dept of Risk Management WC	$46.20
Rate for Payer: Multiplan Commercial	$63.00

HC CULTURE WOUND

Facility

$390.00

Service Code	CPT 87070
Hospital Charge Code	900911520
Hospital Revenue Code	306
Min. Negotiated Rate	$214.50
Max. Negotiated Rate	$312.00
Rate for Payer: Cash Price	$175.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$312.00
Rate for Payer: Health Smart Auto/Commercial	$234.00
Rate for Payer: LLUH Dept of Risk Management WC	$214.50
Rate for Payer: Multiplan Commercial	$292.50

HC CULTURE WOUND

Facility

$84.00

Service Code	CPT 87070
Hospital Charge Code	900911520
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$67.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$50.40
Rate for Payer: Aetna of CA Government/Medicare	$50.40
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cash Price	$37.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$67.20
Rate for Payer: Health Smart Auto/Commercial	$50.40
Rate for Payer: Intervalley Health Plan Commercial	$8.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$50.40
Rate for Payer: LLUH Dept of Risk Management WC	$46.20
Rate for Payer: Multiplan Commercial	$63.00

HC CULTURE YEAST ID

Facility

$331.00

Service Code	CPT 87106
Hospital Charge Code	900911555
Hospital Revenue Code	306
Min. Negotiated Rate	$182.05
Max. Negotiated Rate	$264.80
Rate for Payer: Cash Price	$148.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$264.80
Rate for Payer: Health Smart Auto/Commercial	$198.60
Rate for Payer: LLUH Dept of Risk Management WC	$182.05
Rate for Payer: Multiplan Commercial	$248.25

HC CULTURE YEAST ID

Facility

$88.00

Service Code	CPT 87106
Hospital Charge Code	900911555
Hospital Revenue Code	306
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$70.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$52.80
Rate for Payer: Aetna of CA Government/Medicare	$52.80
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cash Price	$39.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$70.40
Rate for Payer: Health Smart Auto/Commercial	$52.80
Rate for Payer: Intervalley Health Plan Commercial	$10.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$52.80
Rate for Payer: LLUH Dept of Risk Management WC	$48.40
Rate for Payer: Multiplan Commercial	$66.00

HC CULTURE YEAST RAPID ID

Facility

$72.00

Service Code	CPT 87077
Hospital Charge Code	900912425
Hospital Revenue Code	306
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$43.20
Rate for Payer: Aetna of CA Government/Medicare	$43.20
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$57.60
Rate for Payer: Health Smart Auto/Commercial	$43.20
Rate for Payer: Intervalley Health Plan Commercial	$8.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$43.20
Rate for Payer: LLUH Dept of Risk Management WC	$39.60
Rate for Payer: Multiplan Commercial	$54.00

HC CULTURE YEAST RAPID ID

Facility

$200.00

Service Code	CPT 87077
Hospital Charge Code	900912425
Hospital Revenue Code	306
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$160.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$160.00
Rate for Payer: Health Smart Auto/Commercial	$120.00
Rate for Payer: LLUH Dept of Risk Management WC	$110.00
Rate for Payer: Multiplan Commercial	$150.00

HC CULTURE YERSINIA

Facility

$35.00

Service Code	CPT 87046
Hospital Charge Code	900911529
Hospital Revenue Code	306
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.00
Rate for Payer: Aetna of CA Government/Medicare	$21.00
Rate for Payer: Cash Price	$15.75
Rate for Payer: Cash Price	$15.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$28.00
Rate for Payer: Health Smart Auto/Commercial	$21.00
Rate for Payer: Intervalley Health Plan Commercial	$9.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.00
Rate for Payer: LLUH Dept of Risk Management WC	$19.25
Rate for Payer: Multiplan Commercial	$26.25

HC CULTURE YERSINIA

Facility

$280.00

Service Code	CPT 87046
Hospital Charge Code	900911529
Hospital Revenue Code	306
Min. Negotiated Rate	$154.00
Max. Negotiated Rate	$224.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$224.00
Rate for Payer: Health Smart Auto/Commercial	$168.00
Rate for Payer: LLUH Dept of Risk Management WC	$154.00
Rate for Payer: Multiplan Commercial	$210.00

HC CYCLIC CITRUL PEPT AB

Facility

$56.00

Service Code	CPT 86200
Hospital Charge Code	900913652
Hospital Revenue Code	302
Min. Negotiated Rate	$12.95
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	$12.95
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 CYCLIC CITRUL PEPT AB

Facility

$77.00

Service Code	CPT 86200
Hospital Charge Code	900913652
Hospital Revenue Code	302
Min. Negotiated Rate	$42.35
Max. Negotiated Rate	$61.60
Rate for Payer: Cash Price	$34.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$61.60
Rate for Payer: Health Smart Auto/Commercial	$46.20
Rate for Payer: LLUH Dept of Risk Management WC	$42.35
Rate for Payer: Multiplan Commercial	$57.75

HC CYCLOSPORINE A (EMIT)

Facility

$328.00

Service Code	CPT 80158
Hospital Charge Code	900910933
Hospital Revenue Code	301
Min. Negotiated Rate	$180.40
Max. Negotiated Rate	$262.40
Rate for Payer: Cash Price	$147.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$262.40
Rate for Payer: Health Smart Auto/Commercial	$196.80
Rate for Payer: LLUH Dept of Risk Management WC	$180.40
Rate for Payer: Multiplan Commercial	$246.00

HC CYCLOSPORINE A (EMIT)

Facility

$158.00

Service Code	CPT 80158
Hospital Charge Code	900910933
Hospital Revenue Code	301
Min. Negotiated Rate	$18.05
Max. Negotiated Rate	$126.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$94.80
Rate for Payer: Aetna of CA Government/Medicare	$94.80
Rate for Payer: Cash Price	$71.10
Rate for Payer: Cash Price	$71.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$126.40
Rate for Payer: Health Smart Auto/Commercial	$94.80
Rate for Payer: Intervalley Health Plan Commercial	$18.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$94.80
Rate for Payer: LLUH Dept of Risk Management WC	$86.90
Rate for Payer: Multiplan Commercial	$118.50

HC CYTOMEG DNA QUANT

Facility

$266.00

Service Code	CPT 87497
Hospital Charge Code	900912312
Hospital Revenue Code	306
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$212.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$159.60
Rate for Payer: Aetna of CA Government/Medicare	$159.60
Rate for Payer: Cash Price	$119.70
Rate for Payer: Cash Price	$119.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$212.80
Rate for Payer: Health Smart Auto/Commercial	$159.60
Rate for Payer: Intervalley Health Plan Commercial	$42.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$159.60
Rate for Payer: LLUH Dept of Risk Management WC	$146.30
Rate for Payer: Multiplan Commercial	$199.50

HC CYTOMEG DNA QUANT

Facility

$313.00

Service Code	CPT 87497
Hospital Charge Code	900912312
Hospital Revenue Code	306
Min. Negotiated Rate	$172.15
Max. Negotiated Rate	$250.40
Rate for Payer: Cash Price	$140.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$250.40
Rate for Payer: Health Smart Auto/Commercial	$187.80
Rate for Payer: LLUH Dept of Risk Management WC	$172.15
Rate for Payer: Multiplan Commercial	$234.75

HC D DIMER

Facility

$82.00

Service Code	CPT 85379
Hospital Charge Code	900910024
Hospital Revenue Code	305
Min. Negotiated Rate	$10.18
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	$10.18
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 D DIMER

Facility

$245.00

Service Code	CPT 85379
Hospital Charge Code	900910024
Hospital Revenue Code	305
Min. Negotiated Rate	$134.75
Max. Negotiated Rate	$196.00
Rate for Payer: Cash Price	$110.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$196.00
Rate for Payer: Health Smart Auto/Commercial	$147.00
Rate for Payer: LLUH Dept of Risk Management WC	$134.75
Rate for Payer: Multiplan Commercial	$183.75

HC DHEA-S

Facility

$121.00

Service Code	CPT 82627
Hospital Charge Code	900912126
Hospital Revenue Code	301
Min. Negotiated Rate	$66.55
Max. Negotiated Rate	$96.80
Rate for Payer: Cash Price	$54.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$96.80
Rate for Payer: Health Smart Auto/Commercial	$72.60
Rate for Payer: LLUH Dept of Risk Management WC	$66.55
Rate for Payer: Multiplan Commercial	$90.75

HC DHEA-S

Facility

$77.00

Service Code	CPT 82627
Hospital Charge Code	900912126
Hospital Revenue Code	301
Min. Negotiated Rate	$22.23
Max. Negotiated Rate	$61.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$46.20
Rate for Payer: Aetna of CA Government/Medicare	$46.20
Rate for Payer: Cash Price	$34.65
Rate for Payer: Cash Price	$34.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$61.60
Rate for Payer: Health Smart Auto/Commercial	$46.20
Rate for Payer: Intervalley Health Plan Commercial	$22.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$46.20
Rate for Payer: LLUH Dept of Risk Management WC	$42.35
Rate for Payer: Multiplan Commercial	$57.75

HC DIGOXIN

Facility

$191.00

Service Code	CPT 80162
Hospital Charge Code	900910816
Hospital Revenue Code	301
Min. Negotiated Rate	$105.05
Max. Negotiated Rate	$152.80
Rate for Payer: Cash Price	$85.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$152.80
Rate for Payer: Health Smart Auto/Commercial	$114.60
Rate for Payer: LLUH Dept of Risk Management WC	$105.05
Rate for Payer: Multiplan Commercial	$143.25

HC DIGOXIN

Facility

$51.00

Service Code	CPT 80162
Hospital Charge Code	900910816
Hospital Revenue Code	301
Min. Negotiated Rate	$13.28
Max. Negotiated Rate	$40.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.60
Rate for Payer: Aetna of CA Government/Medicare	$30.60
Rate for Payer: Cash Price	$22.95
Rate for Payer: Cash Price	$22.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.80
Rate for Payer: Health Smart Auto/Commercial	$30.60
Rate for Payer: Intervalley Health Plan Commercial	$13.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.60
Rate for Payer: LLUH Dept of Risk Management WC	$28.05
Rate for Payer: Multiplan Commercial	$38.25

HC DNA AB DBL STRANDED

Facility

$214.00

Service Code	CPT 86225
Hospital Charge Code	900913520
Hospital Revenue Code	302
Min. Negotiated Rate	$117.70
Max. Negotiated Rate	$171.20
Rate for Payer: Cash Price	$96.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$171.20
Rate for Payer: Health Smart Auto/Commercial	$128.40
Rate for Payer: LLUH Dept of Risk Management WC	$117.70
Rate for Payer: Multiplan Commercial	$160.50

Know your out-of-pocket cost for care.

All Charges