Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC HSV 1,2 IGM

Facility

$34.00

Service Code	CPT 86694
Hospital Charge Code	900913562
Hospital Revenue Code	302
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$27.20
Rate for Payer: Cash Price	$15.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$27.20
Rate for Payer: Health Smart Auto/Commercial	$20.40
Rate for Payer: LLUH Dept of Risk Management WC	$18.70
Rate for Payer: Multiplan Commercial	$25.50

HC HSV 1&2 PCR

Facility

$230.00

Service Code	CPT 87529
Hospital Charge Code	900912307
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$184.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$138.00
Rate for Payer: Aetna of CA Government/Medicare	$138.00
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cash Price	$103.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$184.00
Rate for Payer: Health Smart Auto/Commercial	$138.00
Rate for Payer: Intervalley Health Plan Commercial	$35.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$138.00
Rate for Payer: LLUH Dept of Risk Management WC	$126.50
Rate for Payer: Multiplan Commercial	$172.50

HC HSV 1&2 PCR

Facility

$250.00

Service Code	CPT 87529
Hospital Charge Code	900912307
Hospital Revenue Code	306
Min. Negotiated Rate	$137.50
Max. Negotiated Rate	$200.00
Rate for Payer: Cash Price	$112.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$200.00
Rate for Payer: Health Smart Auto/Commercial	$150.00
Rate for Payer: LLUH Dept of Risk Management WC	$137.50
Rate for Payer: Multiplan Commercial	$187.50

HC HSV 1 IGG

Facility

$116.00

Service Code	CPT 86695
Hospital Charge Code	900913540
Hospital Revenue Code	302
Min. Negotiated Rate	$13.19
Max. Negotiated Rate	$92.80
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: Cash Price	$52.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$92.80
Rate for Payer: Health Smart Auto/Commercial	$69.60
Rate for Payer: Intervalley Health Plan Commercial	$13.19
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 Commercial	$87.00

HC HSV 1 IGG

Facility

$235.00

Service Code	CPT 86695
Hospital Charge Code	900913540
Hospital Revenue Code	302
Min. Negotiated Rate	$129.25
Max. Negotiated Rate	$188.00
Rate for Payer: Cash Price	$105.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$188.00
Rate for Payer: Health Smart Auto/Commercial	$141.00
Rate for Payer: LLUH Dept of Risk Management WC	$129.25
Rate for Payer: Multiplan Commercial	$176.25

HC HSV 2 IGG

Facility

$120.00

Service Code	CPT 86696
Hospital Charge Code	900913541
Hospital Revenue Code	302
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$96.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$72.00
Rate for Payer: Aetna of CA Government/Medicare	$72.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$96.00
Rate for Payer: Health Smart Auto/Commercial	$72.00
Rate for Payer: Intervalley Health Plan Commercial	$19.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$72.00
Rate for Payer: LLUH Dept of Risk Management WC	$66.00
Rate for Payer: Multiplan Commercial	$90.00

HC HSV 2 IGG

Facility

$235.00

Service Code	CPT 86696
Hospital Charge Code	900913541
Hospital Revenue Code	302
Min. Negotiated Rate	$129.25
Max. Negotiated Rate	$188.00
Rate for Payer: Cash Price	$105.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$188.00
Rate for Payer: Health Smart Auto/Commercial	$141.00
Rate for Payer: LLUH Dept of Risk Management WC	$129.25
Rate for Payer: Multiplan Commercial	$176.25

HC HUMERUS

Facility

$1,046.00

Service Code	CPT 73060
Hospital Charge Code	909001508
Hospital Revenue Code	320
Min. Negotiated Rate	$575.30
Max. Negotiated Rate	$836.80
Rate for Payer: Cash Price	$470.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$836.80
Rate for Payer: Health Smart Auto/Commercial	$627.60
Rate for Payer: LLUH Dept of Risk Management WC	$575.30
Rate for Payer: Multiplan Commercial	$784.50

HC HUMERUS

Facility

$1,046.00

Service Code	CPT 73060
Hospital Charge Code	909001508
Hospital Revenue Code	320
Min. Negotiated Rate	$575.30
Max. Negotiated Rate	$836.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$627.60
Rate for Payer: Aetna of CA Government/Medicare	$627.60
Rate for Payer: Cash Price	$470.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$836.80
Rate for Payer: Health Smart Auto/Commercial	$627.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$627.60
Rate for Payer: LLUH Dept of Risk Management WC	$575.30
Rate for Payer: Multiplan Commercial	$784.50

HC IDENT OF ARTHROPOD

Facility

$23.00

Service Code	CPT 87168
Hospital Charge Code	900912431
Hospital Revenue Code	306
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$18.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.80
Rate for Payer: Aetna of CA Government/Medicare	$13.80
Rate for Payer: Cash Price	$10.35
Rate for Payer: Cash Price	$10.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$18.40
Rate for Payer: Health Smart Auto/Commercial	$13.80
Rate for Payer: Intervalley Health Plan Commercial	$4.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.80
Rate for Payer: LLUH Dept of Risk Management WC	$12.65
Rate for Payer: Multiplan Commercial	$17.25

HC IDENT OF ARTHROPOD

Facility

$165.00

Service Code	CPT 87168
Hospital Charge Code	900912431
Hospital Revenue Code	306
Min. Negotiated Rate	$90.75
Max. Negotiated Rate	$132.00
Rate for Payer: Cash Price	$74.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$132.00
Rate for Payer: Health Smart Auto/Commercial	$99.00
Rate for Payer: LLUH Dept of Risk Management WC	$90.75
Rate for Payer: Multiplan Commercial	$123.75

HC IDENT OF PARASITES

Facility

$46.00

Service Code	CPT 87169
Hospital Charge Code	900911657
Hospital Revenue Code	306
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$36.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.60
Rate for Payer: Aetna of CA Government/Medicare	$27.60
Rate for Payer: Cash Price	$20.70
Rate for Payer: Cash Price	$20.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$36.80
Rate for Payer: Health Smart Auto/Commercial	$27.60
Rate for Payer: Intervalley Health Plan Commercial	$4.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.60
Rate for Payer: LLUH Dept of Risk Management WC	$25.30
Rate for Payer: Multiplan Commercial	$34.50

HC IDENT OF PARASITES

Facility

$165.00

Service Code	CPT 87169
Hospital Charge Code	900911657
Hospital Revenue Code	306
Min. Negotiated Rate	$90.75
Max. Negotiated Rate	$132.00
Rate for Payer: Cash Price	$74.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$132.00
Rate for Payer: Health Smart Auto/Commercial	$99.00
Rate for Payer: LLUH Dept of Risk Management WC	$90.75
Rate for Payer: Multiplan Commercial	$123.75

HC IMIPENEM E TEST

Facility

$18.00

Service Code	CPT 87181
Hospital Charge Code	900912423
Hospital Revenue Code	306
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$14.40
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: Cash Price	$8.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.40
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: Intervalley Health Plan Commercial	$4.75
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 Commercial	$13.50

HC IMIPENEM E TEST

Facility

$103.00

Service Code	CPT 87181
Hospital Charge Code	900912423
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 IMMUNE CELL LUMINESCENCE DET

Facility

$215.00

Service Code	CPT 82397
Hospital Charge Code	900912314
Hospital Revenue Code	302
Min. Negotiated Rate	$118.25
Max. Negotiated Rate	$172.00
Rate for Payer: Cash Price	$96.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$172.00
Rate for Payer: Health Smart Auto/Commercial	$129.00
Rate for Payer: LLUH Dept of Risk Management WC	$118.25
Rate for Payer: Multiplan Commercial	$161.25

HC IMMUNE CELL LUMINESCENCE DET

Facility

$178.00

Service Code	CPT 82397
Hospital Charge Code	900912314
Hospital Revenue Code	302
Min. Negotiated Rate	$14.12
Max. Negotiated Rate	$142.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$106.80
Rate for Payer: Aetna of CA Government/Medicare	$106.80
Rate for Payer: Cash Price	$80.10
Rate for Payer: Cash Price	$80.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$142.40
Rate for Payer: Health Smart Auto/Commercial	$106.80
Rate for Payer: Intervalley Health Plan Commercial	$14.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$106.80
Rate for Payer: LLUH Dept of Risk Management WC	$97.90
Rate for Payer: Multiplan Commercial	$133.50

HC IMMUNE CELL MITOGEN STIM

Facility

$259.00

Service Code	CPT 86353
Hospital Charge Code	900912313
Hospital Revenue Code	302
Min. Negotiated Rate	$49.03
Max. Negotiated Rate	$207.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$155.40
Rate for Payer: Aetna of CA Government/Medicare	$155.40
Rate for Payer: Cash Price	$116.55
Rate for Payer: Cash Price	$116.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$207.20
Rate for Payer: Health Smart Auto/Commercial	$155.40
Rate for Payer: Intervalley Health Plan Commercial	$49.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$155.40
Rate for Payer: LLUH Dept of Risk Management WC	$142.45
Rate for Payer: Multiplan Commercial	$194.25

HC IMMUNE CELL MITOGEN STIM

Facility

$314.00

Service Code	CPT 86353
Hospital Charge Code	900912313
Hospital Revenue Code	302
Min. Negotiated Rate	$172.70
Max. Negotiated Rate	$251.20
Rate for Payer: Cash Price	$141.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$251.20
Rate for Payer: Health Smart Auto/Commercial	$188.40
Rate for Payer: LLUH Dept of Risk Management WC	$172.70
Rate for Payer: Multiplan Commercial	$235.50

HC IMMUNOASSAY QUAN CA 125

Facility

$166.00

Service Code	CPT 86304
Hospital Charge Code	900912122
Hospital Revenue Code	301
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$132.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$99.60
Rate for Payer: Aetna of CA Government/Medicare	$99.60
Rate for Payer: Cash Price	$74.70
Rate for Payer: Cash Price	$74.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$132.80
Rate for Payer: Health Smart Auto/Commercial	$99.60
Rate for Payer: Intervalley Health Plan Commercial	$20.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$99.60
Rate for Payer: LLUH Dept of Risk Management WC	$91.30
Rate for Payer: Multiplan Commercial	$124.50

HC IMMUNOASSAY QUAN CA 125

Facility

$331.00

Service Code	CPT 86304
Hospital Charge Code	900912122
Hospital Revenue Code	301
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 IMMUNOASSAY QUAN CA 15-3

Facility

$95.00

Service Code	CPT 86300
Hospital Charge Code	900912123
Hospital Revenue Code	301
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$76.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$57.00
Rate for Payer: Aetna of CA Government/Medicare	$57.00
Rate for Payer: Cash Price	$42.75
Rate for Payer: Cash Price	$42.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$76.00
Rate for Payer: Health Smart Auto/Commercial	$57.00
Rate for Payer: Intervalley Health Plan Commercial	$20.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$57.00
Rate for Payer: LLUH Dept of Risk Management WC	$52.25
Rate for Payer: Multiplan Commercial	$71.25

HC IMMUNOASSAY QUAN CA 15-3

Facility

$170.00

Service Code	CPT 86300
Hospital Charge Code	900912123
Hospital Revenue Code	301
Min. Negotiated Rate	$93.50
Max. Negotiated Rate	$136.00
Rate for Payer: Cash Price	$76.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$136.00
Rate for Payer: Health Smart Auto/Commercial	$102.00
Rate for Payer: LLUH Dept of Risk Management WC	$93.50
Rate for Payer: Multiplan Commercial	$127.50

HC IMMUNOASSAY QUAN CA 19-9

Facility

$331.00

Service Code	CPT 86301
Hospital Charge Code	900912124
Hospital Revenue Code	301
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 IMMUNOASSAY QUAN CA 19-9

Facility

$166.00

Service Code	CPT 86301
Hospital Charge Code	900912124
Hospital Revenue Code	301
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$132.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$99.60
Rate for Payer: Aetna of CA Government/Medicare	$99.60
Rate for Payer: Cash Price	$74.70
Rate for Payer: Cash Price	$74.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$132.80
Rate for Payer: Health Smart Auto/Commercial	$99.60
Rate for Payer: Intervalley Health Plan Commercial	$20.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$99.60
Rate for Payer: LLUH Dept of Risk Management WC	$91.30
Rate for Payer: Multiplan Commercial	$124.50

Know your out-of-pocket cost for care.

All Charges