Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SED RATE WESTERGRN AUTOMATED

Facility

$125.00

Service Code	CPT 85652
Hospital Charge Code	900910025
Hospital Revenue Code	305
Min. Negotiated Rate	$68.75
Max. Negotiated Rate	$100.00
Rate for Payer: Cash Price	$56.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$100.00
Rate for Payer: Health Smart Auto/Commercial	$75.00
Rate for Payer: LLUH Dept of Risk Management WC	$68.75
Rate for Payer: Multiplan Commercial	$93.75

HC SED RATE WESTERGRN AUTOMATED

Facility

$28.00

Service Code	CPT 85652
Hospital Charge Code	900910025
Hospital Revenue Code	305
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$22.40
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: Cash Price	$12.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.40
Rate for Payer: Health Smart Auto/Commercial	$16.80
Rate for Payer: Intervalley Health Plan Commercial	$2.70
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 Commercial	$21.00

HC SEMEN ANALYSIS

Facility

$112.00

Service Code	CPT 89320
Hospital Charge Code	900910151
Hospital Revenue Code	300
Min. Negotiated Rate	$12.31
Max. Negotiated Rate	$89.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$67.20
Rate for Payer: Aetna of CA Government/Medicare	$67.20
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$89.60
Rate for Payer: Health Smart Auto/Commercial	$67.20
Rate for Payer: Intervalley Health Plan Commercial	$12.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$67.20
Rate for Payer: LLUH Dept of Risk Management WC	$61.60
Rate for Payer: Multiplan Commercial	$84.00

HC SEMEN ANALYSIS

Facility

$397.00

Service Code	CPT 89320
Hospital Charge Code	900910151
Hospital Revenue Code	300
Min. Negotiated Rate	$218.35
Max. Negotiated Rate	$317.60
Rate for Payer: Cash Price	$178.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$317.60
Rate for Payer: Health Smart Auto/Commercial	$238.20
Rate for Payer: LLUH Dept of Risk Management WC	$218.35
Rate for Payer: Multiplan Commercial	$297.75

HC SENSITIVITY GRAM NEGATIVE MIC

Facility

$313.00

Service Code	CPT 87186
Hospital Charge Code	900912414
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 SENSITIVITY GRAM NEGATIVE MIC

Facility

$88.00

Service Code	CPT 87186
Hospital Charge Code	900912414
Hospital Revenue Code	306
Min. Negotiated Rate	$8.65
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	$8.65
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 SENSITIVITY GRAM POSITIVE MIC

Facility

$313.00

Service Code	CPT 87186
Hospital Charge Code	900912412
Hospital Revenue Code	300
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 SENSITIVITY GRAM POSITIVE MIC

Facility

$88.00

Service Code	CPT 87186
Hospital Charge Code	900912412
Hospital Revenue Code	300
Min. Negotiated Rate	$8.65
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	$8.65
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 SENSITIVITY MIC

Facility

$313.00

Service Code	CPT 87186
Hospital Charge Code	900911558
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 SENSITIVITY MIC

Facility

$88.00

Service Code	CPT 87186
Hospital Charge Code	900911558
Hospital Revenue Code	306
Min. Negotiated Rate	$8.65
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	$8.65
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 SENSITIVITY STREP MIC

Facility

$313.00

Service Code	CPT 87186
Hospital Charge Code	900912413
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 SENSITIVITY STREP MIC

Facility

$88.00

Service Code	CPT 87186
Hospital Charge Code	900912413
Hospital Revenue Code	306
Min. Negotiated Rate	$8.65
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	$8.65
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 SHIGATOXIN

Facility

$99.00

Service Code	CPT 87427
Hospital Charge Code	900912326
Hospital Revenue Code	302
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$79.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$59.40
Rate for Payer: Aetna of CA Government/Medicare	$59.40
Rate for Payer: Cash Price	$44.55
Rate for Payer: Cash Price	$44.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$79.20
Rate for Payer: Health Smart Auto/Commercial	$59.40
Rate for Payer: Intervalley Health Plan Commercial	$11.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$59.40
Rate for Payer: LLUH Dept of Risk Management WC	$54.45
Rate for Payer: Multiplan Commercial	$74.25

HC SHIGATOXIN

Facility

$186.00

Service Code	CPT 87427
Hospital Charge Code	900912326
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 SHOULDER COMPLETE UNILAT

Facility

$1,153.00

Service Code	CPT 73030
Hospital Charge Code	909001504
Hospital Revenue Code	320
Min. Negotiated Rate	$634.15
Max. Negotiated Rate	$922.40
Rate for Payer: Cash Price	$518.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$922.40
Rate for Payer: Health Smart Auto/Commercial	$691.80
Rate for Payer: LLUH Dept of Risk Management WC	$634.15
Rate for Payer: Multiplan Commercial	$864.75

HC SHOULDER COMPLETE UNILAT

Facility

$1,153.00

Service Code	CPT 73030
Hospital Charge Code	909001504
Hospital Revenue Code	320
Min. Negotiated Rate	$634.15
Max. Negotiated Rate	$922.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$691.80
Rate for Payer: Aetna of CA Government/Medicare	$691.80
Rate for Payer: Cash Price	$518.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$922.40
Rate for Payer: Health Smart Auto/Commercial	$691.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$691.80
Rate for Payer: LLUH Dept of Risk Management WC	$634.15
Rate for Payer: Multiplan Commercial	$864.75

HC SHOULDER LIMITED

Facility

$973.00

Service Code	CPT 73020
Hospital Charge Code	909001505
Hospital Revenue Code	320
Min. Negotiated Rate	$535.15
Max. Negotiated Rate	$778.40
Rate for Payer: Cash Price	$437.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$778.40
Rate for Payer: Health Smart Auto/Commercial	$583.80
Rate for Payer: LLUH Dept of Risk Management WC	$535.15
Rate for Payer: Multiplan Commercial	$729.75

HC SHOULDER LIMITED

Facility

$973.00

Service Code	CPT 73020
Hospital Charge Code	909001505
Hospital Revenue Code	320
Min. Negotiated Rate	$535.15
Max. Negotiated Rate	$778.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$583.80
Rate for Payer: Aetna of CA Government/Medicare	$583.80
Rate for Payer: Cash Price	$437.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$778.40
Rate for Payer: Health Smart Auto/Commercial	$583.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$583.80
Rate for Payer: LLUH Dept of Risk Management WC	$535.15
Rate for Payer: Multiplan Commercial	$729.75

HC SICKLE CELL SCREEN

Facility

$59.00

Service Code	CPT 85660
Hospital Charge Code	900910034
Hospital Revenue Code	305
Min. Negotiated Rate	$5.51
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	$5.51
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 SICKLE CELL SCREEN

Facility

$96.00

Service Code	CPT 85660
Hospital Charge Code	900910034
Hospital Revenue Code	305
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$76.80
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: LLUH Dept of Risk Management WC	$52.80
Rate for Payer: Multiplan Commercial	$72.00

HC SINUS/ PARANASAL COMPLETE

Facility

$1,722.00

Service Code	CPT 70220
Hospital Charge Code	909001141
Hospital Revenue Code	320
Min. Negotiated Rate	$947.10
Max. Negotiated Rate	$1,377.60
Rate for Payer: Cash Price	$774.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,377.60
Rate for Payer: Health Smart Auto/Commercial	$1,033.20
Rate for Payer: LLUH Dept of Risk Management WC	$947.10
Rate for Payer: Multiplan Commercial	$1,291.50

HC SINUS/ PARANASAL COMPLETE

Facility

$1,722.00

Service Code	CPT 70220
Hospital Charge Code	909001141
Hospital Revenue Code	320
Min. Negotiated Rate	$947.10
Max. Negotiated Rate	$1,377.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,033.20
Rate for Payer: Aetna of CA Government/Medicare	$1,033.20
Rate for Payer: Cash Price	$774.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,377.60
Rate for Payer: Health Smart Auto/Commercial	$1,033.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,033.20
Rate for Payer: LLUH Dept of Risk Management WC	$947.10
Rate for Payer: Multiplan Commercial	$1,291.50

HC SIROLIMUS

Facility

$211.00

Service Code	CPT 80195
Hospital Charge Code	900912167
Hospital Revenue Code	301
Min. Negotiated Rate	$116.05
Max. Negotiated Rate	$168.80
Rate for Payer: Cash Price	$94.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$168.80
Rate for Payer: Health Smart Auto/Commercial	$126.60
Rate for Payer: LLUH Dept of Risk Management WC	$116.05
Rate for Payer: Multiplan Commercial	$158.25

HC SIROLIMUS

Facility

$126.00

Service Code	CPT 80195
Hospital Charge Code	900912167
Hospital Revenue Code	301
Min. Negotiated Rate	$13.73
Max. Negotiated Rate	$100.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$75.60
Rate for Payer: Aetna of CA Government/Medicare	$75.60
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cash Price	$56.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$100.80
Rate for Payer: Health Smart Auto/Commercial	$75.60
Rate for Payer: Intervalley Health Plan Commercial	$13.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$75.60
Rate for Payer: LLUH Dept of Risk Management WC	$69.30
Rate for Payer: Multiplan Commercial	$94.50

HC SKULL COMPLETE

Facility

$1,568.00

Service Code	CPT 70260
Hospital Charge Code	909001143
Hospital Revenue Code	320
Min. Negotiated Rate	$862.40
Max. Negotiated Rate	$1,254.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$940.80
Rate for Payer: Aetna of CA Government/Medicare	$940.80
Rate for Payer: Cash Price	$705.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,254.40
Rate for Payer: Health Smart Auto/Commercial	$940.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$940.80
Rate for Payer: LLUH Dept of Risk Management WC	$862.40
Rate for Payer: Multiplan Commercial	$1,176.00

Know your out-of-pocket cost for care.

All Charges