Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC CULTURE URINE ID

Facility

$27.00

Service Code	CPT 87088
Hospital Charge Code	900911556
Hospital Revenue Code	306
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$20.25
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: Health Smart Auto/Commercial	$16.20
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 Beech St/Commercial/PHCS	$20.25

HC CULTURE UROGENITAL

Facility

$32.00

Service Code	CPT 87070
Hospital Charge Code	900911519
Hospital Revenue Code	306
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.20
Rate for Payer: Aetna of CA Government/Medicare	$19.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Smart Auto/Commercial	$19.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.20
Rate for Payer: LLUH Dept of Risk Management WC	$17.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.00

HC CULTURE UROGENITAL

Facility

$399.00

Service Code	CPT 87070
Hospital Charge Code	900911519
Hospital Revenue Code	306
Min. Negotiated Rate	$219.45
Max. Negotiated Rate	$319.20
Rate for Payer: Cash Price	$179.55
Rate for Payer: Cigna of CA HMO/PPO	$319.20
Rate for Payer: Health Smart Auto/Commercial	$239.40
Rate for Payer: LLUH Dept of Risk Management WC	$219.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$299.25

HC CULTURE WOUND

Facility

$32.00

Service Code	CPT 87070
Hospital Charge Code	900911520
Hospital Revenue Code	306
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.20
Rate for Payer: Aetna of CA Government/Medicare	$19.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Smart Auto/Commercial	$19.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.20
Rate for Payer: LLUH Dept of Risk Management WC	$17.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.00

HC CULTURE WOUND

Facility

$399.00

Service Code	CPT 87070
Hospital Charge Code	900911520
Hospital Revenue Code	306
Min. Negotiated Rate	$219.45
Max. Negotiated Rate	$319.20
Rate for Payer: Cash Price	$179.55
Rate for Payer: Cigna of CA HMO/PPO	$319.20
Rate for Payer: Health Smart Auto/Commercial	$239.40
Rate for Payer: LLUH Dept of Risk Management WC	$219.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$299.25

HC CULTURE YEAST ID

Facility

$288.00

Service Code	CPT 87106
Hospital Charge Code	900911555
Hospital Revenue Code	306
Min. Negotiated Rate	$158.40
Max. Negotiated Rate	$230.40
Rate for Payer: Cash Price	$129.60
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$216.00

HC CULTURE YEAST ID

Facility

$34.00

Service Code	CPT 87106
Hospital Charge Code	900911555
Hospital Revenue Code	306
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.40
Rate for Payer: Aetna of CA Government/Medicare	$20.40
Rate for Payer: Cash Price	$15.30
Rate for Payer: Health Smart Auto/Commercial	$20.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.40
Rate for Payer: LLUH Dept of Risk Management WC	$18.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.50

HC CULTURE YEAST RAPID ID

Facility

$204.00

Service Code	CPT 87077
Hospital Charge Code	900912425
Hospital Revenue Code	306
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$163.20
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna of CA HMO/PPO	$163.20
Rate for Payer: Health Smart Auto/Commercial	$122.40
Rate for Payer: LLUH Dept of Risk Management WC	$112.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$153.00

HC CULTURE YEAST RAPID ID

Facility

$31.00

Service Code	CPT 87077
Hospital Charge Code	900912425
Hospital Revenue Code	306
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$23.25
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: Health Smart Auto/Commercial	$18.60
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 Beech St/Commercial/PHCS	$23.25

HC CULTURE YERSINIA

Facility

$36.00

Service Code	CPT 87046
Hospital Charge Code	900911529
Hospital Revenue Code	306
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.60
Rate for Payer: Aetna of CA Government/Medicare	$21.60
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.00

HC CULTURE YERSINIA

Facility

$399.00

Service Code	CPT 87046
Hospital Charge Code	900911529
Hospital Revenue Code	306
Min. Negotiated Rate	$219.45
Max. Negotiated Rate	$319.20
Rate for Payer: Cash Price	$179.55
Rate for Payer: Cigna of CA HMO/PPO	$319.20
Rate for Payer: Health Smart Auto/Commercial	$239.40
Rate for Payer: LLUH Dept of Risk Management WC	$219.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$299.25

HC CYCLIC CITRUL PEPT AB

Facility

$39.00

Service Code	CPT 86200
Hospital Charge Code	900913652
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 CYCLIC CITRUL PEPT AB

Facility

$58.00

Service Code	CPT 86200
Hospital Charge Code	900913652
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 CYCLOSPORINE A (EMIT)

Facility

$248.00

Service Code	CPT 80158
Hospital Charge Code	900910933
Hospital Revenue Code	301
Min. Negotiated Rate	$136.40
Max. Negotiated Rate	$198.40
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cigna of CA HMO/PPO	$198.40
Rate for Payer: Health Smart Auto/Commercial	$148.80
Rate for Payer: LLUH Dept of Risk Management WC	$136.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$186.00

HC CYCLOSPORINE A (EMIT)

Facility

$69.00

Service Code	CPT 80158
Hospital Charge Code	900910933
Hospital Revenue Code	301
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$51.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$41.40
Rate for Payer: Aetna of CA Government/Medicare	$41.40
Rate for Payer: Cash Price	$31.05
Rate for Payer: Health Smart Auto/Commercial	$41.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$41.40
Rate for Payer: LLUH Dept of Risk Management WC	$37.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$51.75

HC CYTOMEG DNA QUANT

Facility

$320.00

Service Code	CPT 87497
Hospital Charge Code	900912312
Hospital Revenue Code	306
Min. Negotiated Rate	$176.00
Max. Negotiated Rate	$256.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna of CA HMO/PPO	$256.00
Rate for Payer: Health Smart Auto/Commercial	$192.00
Rate for Payer: LLUH Dept of Risk Management WC	$176.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$240.00

HC CYTOMEG DNA QUANT

Facility

$116.00

Service Code	CPT 87497
Hospital Charge Code	900912312
Hospital Revenue Code	306
Min. Negotiated Rate	$63.80
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$69.60
Rate for Payer: Aetna of CA Government/Medicare	$69.60
Rate for Payer: Cash Price	$52.20
Rate for Payer: Health Smart Auto/Commercial	$69.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$69.60
Rate for Payer: LLUH Dept of Risk Management WC	$63.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$87.00

HC D DIMER

Facility

$258.00

Service Code	CPT 85379
Hospital Charge Code	900910024
Hospital Revenue Code	305
Min. Negotiated Rate	$141.90
Max. Negotiated Rate	$206.40
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cigna of CA HMO/PPO	$206.40
Rate for Payer: Health Smart Auto/Commercial	$154.80
Rate for Payer: LLUH Dept of Risk Management WC	$141.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$193.50

HC D DIMER

Facility

$31.00

Service Code	CPT 85379
Hospital Charge Code	900910024
Hospital Revenue Code	305
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$23.25
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: Health Smart Auto/Commercial	$18.60
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 Beech St/Commercial/PHCS	$23.25

HC DHEA-S

Facility

$406.00

Service Code	CPT 82627
Hospital Charge Code	900912126
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 DHEA-S

Facility

$67.00

Service Code	CPT 82627
Hospital Charge Code	900912126
Hospital Revenue Code	301
Min. Negotiated Rate	$36.85
Max. Negotiated Rate	$50.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$40.20
Rate for Payer: Aetna of CA Government/Medicare	$40.20
Rate for Payer: Cash Price	$30.15
Rate for Payer: Health Smart Auto/Commercial	$40.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$40.20
Rate for Payer: LLUH Dept of Risk Management WC	$36.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$50.25

HC DIGOXIN

Facility

$50.00

Service Code	CPT 80162
Hospital Charge Code	900910816
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.50

HC DIGOXIN

Facility

$196.00

Service Code	CPT 80162
Hospital Charge Code	900910816
Hospital Revenue Code	301
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$156.80
Rate for Payer: Cash Price	$88.20
Rate for Payer: Cigna of CA HMO/PPO	$156.80
Rate for Payer: Health Smart Auto/Commercial	$117.60
Rate for Payer: LLUH Dept of Risk Management WC	$107.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$147.00

HC DNA AB DBL STRANDED

Facility

$162.00

Service Code	CPT 86225
Hospital Charge Code	900913520
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 DNA AB DBL STRANDED

Facility

$21.00

Service Code	CPT 86225
Hospital Charge Code	900913520
Hospital Revenue Code	302
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$15.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.60
Rate for Payer: Aetna of CA Government/Medicare	$12.60
Rate for Payer: Cash Price	$9.45
Rate for Payer: Health Smart Auto/Commercial	$12.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.60
Rate for Payer: LLUH Dept of Risk Management WC	$11.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.75

Know your out-of-pocket cost for care.

All Charges