Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC IDENT OF PARASITES

Facility

$17.00

Service Code	CPT 87169
Hospital Charge Code	900911657
Hospital Revenue Code	306
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$12.75
Rate for Payer: Health Smart Auto/Commercial	$10.20
Rate for Payer: Cash Price	$7.65
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.20
Rate for Payer: Aetna of CA Government/Medicare	$10.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.20
Rate for Payer: LLUH Dept of Risk Management WC	$9.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.75

HC IDENT OF PARASITES

Facility

$169.00

Service Code	CPT 87169
Hospital Charge Code	900911657
Hospital Revenue Code	306
Min. Negotiated Rate	$92.95
Max. Negotiated Rate	$135.20
Rate for Payer: Cash Price	$76.05
Rate for Payer: Cigna of CA HMO/PPO	$135.20
Rate for Payer: Health Smart Auto/Commercial	$101.40
Rate for Payer: LLUH Dept of Risk Management WC	$92.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$126.75

HC IMIPENEM E TEST

Facility

$105.00

Service Code	CPT 87181
Hospital Charge Code	900912423
Hospital Revenue Code	306
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$84.00
Rate for Payer: Cash Price	$47.25
Rate for Payer: Cigna of CA HMO/PPO	$84.00
Rate for Payer: Health Smart Auto/Commercial	$63.00
Rate for Payer: LLUH Dept of Risk Management WC	$57.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$78.75

HC IMIPENEM E TEST

Facility

$18.00

Service Code	CPT 87181
Hospital Charge Code	900912423
Hospital Revenue Code	306
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$13.50
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: Health Smart Auto/Commercial	$10.80
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 Beech St/Commercial/PHCS	$13.50

HC IMMUNE CELL LUMINESCENCE DET

Facility

$161.00

Service Code	CPT 82397
Hospital Charge Code	900912314
Hospital Revenue Code	302
Min. Negotiated Rate	$88.55
Max. Negotiated Rate	$120.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$96.60
Rate for Payer: Aetna of CA Government/Medicare	$96.60
Rate for Payer: Cash Price	$72.45
Rate for Payer: Health Smart Auto/Commercial	$96.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$96.60
Rate for Payer: LLUH Dept of Risk Management WC	$88.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$120.75

HC IMMUNE CELL LUMINESCENCE DET

Facility

$194.00

Service Code	CPT 82397
Hospital Charge Code	900912314
Hospital Revenue Code	302
Min. Negotiated Rate	$106.70
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$87.30
Rate for Payer: Cigna of CA HMO/PPO	$155.20
Rate for Payer: Health Smart Auto/Commercial	$116.40
Rate for Payer: LLUH Dept of Risk Management WC	$106.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$145.50

HC IMMUNE CELL MITOGEN STIM

Facility

$237.00

Service Code	CPT 86353
Hospital Charge Code	900912313
Hospital Revenue Code	302
Min. Negotiated Rate	$130.35
Max. Negotiated Rate	$189.60
Rate for Payer: Cash Price	$106.65
Rate for Payer: Cigna of CA HMO/PPO	$189.60
Rate for Payer: Health Smart Auto/Commercial	$142.20
Rate for Payer: LLUH Dept of Risk Management WC	$130.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$177.75

HC IMMUNE CELL MITOGEN STIM

Facility

$196.00

Service Code	CPT 86353
Hospital Charge Code	900912313
Hospital Revenue Code	302
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$147.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$117.60
Rate for Payer: Aetna of CA Government/Medicare	$117.60
Rate for Payer: Cash Price	$88.20
Rate for Payer: Health Smart Auto/Commercial	$117.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$117.60
Rate for Payer: LLUH Dept of Risk Management WC	$107.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$147.00

HC IMMUNOASSAY QUAN CA 125

Facility

$72.00

Service Code	CPT 86304
Hospital Charge Code	900912122
Hospital Revenue Code	301
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$54.00
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: Health Smart Auto/Commercial	$43.20
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 Beech St/Commercial/PHCS	$54.00

HC IMMUNOASSAY QUAN CA 125

Facility

$250.00

Service Code	CPT 86304
Hospital Charge Code	900912122
Hospital Revenue Code	301
Min. Negotiated Rate	$137.50
Max. Negotiated Rate	$200.00
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$187.50

HC IMMUNOASSAY QUAN CA 15-3

Facility

$216.00

Service Code	CPT 86300
Hospital Charge Code	900912123
Hospital Revenue Code	301
Min. Negotiated Rate	$118.80
Max. Negotiated Rate	$172.80
Rate for Payer: Cash Price	$97.20
Rate for Payer: Cigna of CA HMO/PPO	$172.80
Rate for Payer: Health Smart Auto/Commercial	$129.60
Rate for Payer: LLUH Dept of Risk Management WC	$118.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$162.00

HC IMMUNOASSAY QUAN CA 15-3

Facility

$72.00

Service Code	CPT 86300
Hospital Charge Code	900912123
Hospital Revenue Code	301
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$54.00
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: Health Smart Auto/Commercial	$43.20
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 Beech St/Commercial/PHCS	$54.00

HC IMMUNOASSAY QUAN CA 19-9

Facility

$250.00

Service Code	CPT 86301
Hospital Charge Code	900912124
Hospital Revenue Code	301
Min. Negotiated Rate	$137.50
Max. Negotiated Rate	$200.00
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$187.50

HC IMMUNOASSAY QUAN CA 19-9

Facility

$72.00

Service Code	CPT 86301
Hospital Charge Code	900912124
Hospital Revenue Code	301
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$54.00
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: Health Smart Auto/Commercial	$43.20
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 Beech St/Commercial/PHCS	$54.00

HC IMMUNOGLOBULIN E

Facility

$39.00

Service Code	CPT 82785
Hospital Charge Code	900912129
Hospital Revenue Code	301
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 IMMUNOGLOBULIN E

Facility

$218.00

Service Code	CPT 82785
Hospital Charge Code	900912129
Hospital Revenue Code	301
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$174.40
Rate for Payer: Cash Price	$98.10
Rate for Payer: Cigna of CA HMO/PPO	$174.40
Rate for Payer: Health Smart Auto/Commercial	$130.80
Rate for Payer: LLUH Dept of Risk Management WC	$119.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$163.50

HC IMMUNOGLOBULINS IGA

Facility

$29.00

Service Code	CPT 82784
Hospital Charge Code	900910855
Hospital Revenue Code	301
Min. Negotiated Rate	$15.95
Max. Negotiated Rate	$21.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$17.40
Rate for Payer: Aetna of CA Government/Medicare	$17.40
Rate for Payer: Cash Price	$13.05
Rate for Payer: Health Smart Auto/Commercial	$17.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$17.40
Rate for Payer: LLUH Dept of Risk Management WC	$15.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21.75

HC IMMUNOGLOBULINS IGA

Facility

$190.00

Service Code	CPT 82784
Hospital Charge Code	900910855
Hospital Revenue Code	301
Min. Negotiated Rate	$104.50
Max. Negotiated Rate	$152.00
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cigna of CA HMO/PPO	$152.00
Rate for Payer: Health Smart Auto/Commercial	$114.00
Rate for Payer: LLUH Dept of Risk Management WC	$104.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$142.50

HC IMMUNOGLOBULINS IGG

Facility

$29.00

Service Code	CPT 82784
Hospital Charge Code	900910857
Hospital Revenue Code	301
Min. Negotiated Rate	$15.95
Max. Negotiated Rate	$21.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$17.40
Rate for Payer: Aetna of CA Government/Medicare	$17.40
Rate for Payer: Cash Price	$13.05
Rate for Payer: Health Smart Auto/Commercial	$17.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$17.40
Rate for Payer: LLUH Dept of Risk Management WC	$15.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21.75

HC IMMUNOGLOBULINS IGG

Facility

$161.00

Service Code	CPT 82784
Hospital Charge Code	900910857
Hospital Revenue Code	301
Min. Negotiated Rate	$88.55
Max. Negotiated Rate	$128.80
Rate for Payer: Cash Price	$72.45
Rate for Payer: Cigna of CA HMO/PPO	$128.80
Rate for Payer: Health Smart Auto/Commercial	$96.60
Rate for Payer: LLUH Dept of Risk Management WC	$88.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$120.75

HC IMMUNOGLOBULINS IGM

Facility

$190.00

Service Code	CPT 82784
Hospital Charge Code	900910856
Hospital Revenue Code	301
Min. Negotiated Rate	$104.50
Max. Negotiated Rate	$152.00
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cigna of CA HMO/PPO	$152.00
Rate for Payer: Health Smart Auto/Commercial	$114.00
Rate for Payer: LLUH Dept of Risk Management WC	$104.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$142.50

HC IMMUNOGLOBULINS IGM

Facility

$29.00

Service Code	CPT 82784
Hospital Charge Code	900910856
Hospital Revenue Code	301
Min. Negotiated Rate	$15.95
Max. Negotiated Rate	$21.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$17.40
Rate for Payer: Aetna of CA Government/Medicare	$17.40
Rate for Payer: Cash Price	$13.05
Rate for Payer: Health Smart Auto/Commercial	$17.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$17.40
Rate for Payer: LLUH Dept of Risk Management WC	$15.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21.75

HC IMMUNOTYPING ELECTROPHORESIS

Facility

$255.00

Service Code	CPT 86334
Hospital Charge Code	900913611
Hospital Revenue Code	301
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$204.00
Rate for Payer: Cash Price	$114.75
Rate for Payer: Cigna of CA HMO/PPO	$204.00
Rate for Payer: Health Smart Auto/Commercial	$153.00
Rate for Payer: LLUH Dept of Risk Management WC	$140.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$191.25

HC IMMUNOTYPING ELECTROPHORESIS

Facility

$85.00

Service Code	CPT 86334
Hospital Charge Code	900913611
Hospital Revenue Code	301
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$63.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$51.00
Rate for Payer: Aetna of CA Government/Medicare	$51.00
Rate for Payer: Cash Price	$38.25
Rate for Payer: Health Smart Auto/Commercial	$51.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$51.00
Rate for Payer: LLUH Dept of Risk Management WC	$46.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$63.75

HC INDIV BRIEF THERAPY

Facility

$325.00

Service Code	CPT 90832
Hospital Charge Code	907804005
Hospital Revenue Code	914
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$102.00
Rate for Payer: Aetna of CA Government/Medicare	$102.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Health Smart Auto/Commercial	$195.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$195.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Mary Free Bed Workers' Compensation	$75.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

Know your out-of-pocket cost for care.

All Charges