Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC LAB REF TIAGABINE LEVEL

Facility

$99.00

Service Code	CPT 80199 90
Hospital Charge Code	900912716
Hospital Revenue Code	301
Min. Negotiated Rate	$54.45
Max. Negotiated Rate	$79.20
Rate for Payer: Cash Price	$44.55
Rate for Payer: Cigna of CA HMO/PPO	$79.20
Rate for Payer: Health Smart Auto/Commercial	$59.40
Rate for Payer: LLUH Dept of Risk Management WC	$54.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$74.25

HC LAB REF TIAGABINE LEVEL

Facility

$99.00

Service Code	CPT 80199
Hospital Charge Code	900912716
Hospital Revenue Code	301
Min. Negotiated Rate	$54.45
Max. Negotiated Rate	$74.25
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: Health Smart Auto/Commercial	$59.40
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 Beech St/Commercial/PHCS	$74.25

HC LAB REF TISSUE CULT OTHER SOLID TISSUE

Facility

$75.00

Service Code	CPT 88291
Hospital Charge Code	900910776
Hospital Revenue Code	310
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$56.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$45.00
Rate for Payer: Aetna of CA Government/Medicare	$45.00
Rate for Payer: Cash Price	$33.75
Rate for Payer: Health Smart Auto/Commercial	$45.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$45.00
Rate for Payer: LLUH Dept of Risk Management WC	$41.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$56.25

HC LAB REF TISSUE CULT OTHER SOLID TISSUE

Facility

$75.00

Service Code	CPT 88291 90
Hospital Charge Code	900910776
Hospital Revenue Code	310
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$56.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$45.00
Rate for Payer: Aetna of CA Government/Medicare	$45.00
Rate for Payer: Cash Price	$33.75
Rate for Payer: Health Smart Auto/Commercial	$45.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$45.00
Rate for Payer: LLUH Dept of Risk Management WC	$41.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$56.25

HC LAB REF TISSUE CULT OTHER SOLID TISSUE

Facility

$75.00

Service Code	CPT 88291
Hospital Charge Code	900910776
Hospital Revenue Code	310
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$60.00
Rate for Payer: Cash Price	$33.75
Rate for Payer: Cigna of CA HMO/PPO	$60.00
Rate for Payer: Health Smart Auto/Commercial	$45.00
Rate for Payer: LLUH Dept of Risk Management WC	$41.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$56.25

HC LAB REF TISSUE CULT OTHER SOLID TISSUE

Facility

$75.00

Service Code	CPT 88291 90
Hospital Charge Code	900910776
Hospital Revenue Code	310
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$60.00
Rate for Payer: Cash Price	$33.75
Rate for Payer: Cigna of CA HMO/PPO	$60.00
Rate for Payer: Health Smart Auto/Commercial	$45.00
Rate for Payer: LLUH Dept of Risk Management WC	$41.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$56.25

HC LAB REF TISSUE CULTURE LYMPHOCYTE NON

Facility

$101.00

Service Code	CPT 88230
Hospital Charge Code	900910686
Hospital Revenue Code	310
Min. Negotiated Rate	$55.55
Max. Negotiated Rate	$80.80
Rate for Payer: Cash Price	$45.45
Rate for Payer: Cigna of CA HMO/PPO	$80.80
Rate for Payer: Health Smart Auto/Commercial	$60.60
Rate for Payer: LLUH Dept of Risk Management WC	$55.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$75.75

HC LAB REF TISSUE CULTURE LYMPHOCYTE NON

Facility

$101.00

Service Code	CPT 88230
Hospital Charge Code	900910686
Hospital Revenue Code	310
Min. Negotiated Rate	$55.55
Max. Negotiated Rate	$75.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$60.60
Rate for Payer: Aetna of CA Government/Medicare	$60.60
Rate for Payer: Cash Price	$45.45
Rate for Payer: Health Smart Auto/Commercial	$60.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$60.60
Rate for Payer: LLUH Dept of Risk Management WC	$55.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$75.75

HC LAB REF TISSUE CULTURE LYMPHOCYTE NON

Facility

$101.00

Service Code	CPT 88230 90
Hospital Charge Code	900910686
Hospital Revenue Code	310
Min. Negotiated Rate	$55.55
Max. Negotiated Rate	$80.80
Rate for Payer: Cash Price	$45.45
Rate for Payer: Cigna of CA HMO/PPO	$80.80
Rate for Payer: Health Smart Auto/Commercial	$60.60
Rate for Payer: LLUH Dept of Risk Management WC	$55.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$75.75

HC LAB REF TISSUE CULTURE LYMPHOCYTE NON

Facility

$101.00

Service Code	CPT 88230 90
Hospital Charge Code	900910686
Hospital Revenue Code	310
Min. Negotiated Rate	$55.55
Max. Negotiated Rate	$75.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$60.60
Rate for Payer: Aetna of CA Government/Medicare	$60.60
Rate for Payer: Cash Price	$45.45
Rate for Payer: Health Smart Auto/Commercial	$60.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$60.60
Rate for Payer: LLUH Dept of Risk Management WC	$55.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$75.75

HC LAB REF TISSUE CULTURE NEO BLOOD/BONE

Facility

$203.00

Service Code	CPT 88237
Hospital Charge Code	900912791
Hospital Revenue Code	310
Min. Negotiated Rate	$111.65
Max. Negotiated Rate	$162.40
Rate for Payer: Cash Price	$91.35
Rate for Payer: Cigna of CA HMO/PPO	$162.40
Rate for Payer: Health Smart Auto/Commercial	$121.80
Rate for Payer: LLUH Dept of Risk Management WC	$111.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$152.25

HC LAB REF TISSUE CULTURE NEO BLOOD/BONE

Facility

$203.00

Service Code	CPT 88237 TC
Hospital Charge Code	900912791
Hospital Revenue Code	310
Min. Negotiated Rate	$111.65
Max. Negotiated Rate	$152.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$121.80
Rate for Payer: Aetna of CA Government/Medicare	$121.80
Rate for Payer: Cash Price	$91.35
Rate for Payer: Health Smart Auto/Commercial	$121.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$121.80
Rate for Payer: LLUH Dept of Risk Management WC	$111.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$152.25

HC LAB REF TISSUE CULTURE NEO BLOOD/BONE

Facility

$203.00

Service Code	CPT 88237
Hospital Charge Code	900912791
Hospital Revenue Code	310
Min. Negotiated Rate	$111.65
Max. Negotiated Rate	$152.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$121.80
Rate for Payer: Aetna of CA Government/Medicare	$121.80
Rate for Payer: Cash Price	$91.35
Rate for Payer: Health Smart Auto/Commercial	$121.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$121.80
Rate for Payer: LLUH Dept of Risk Management WC	$111.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$152.25

HC LAB REF TISSUE CULTURE NEO BLOOD/BONE

Facility

$203.00

Service Code	CPT 88237 TC
Hospital Charge Code	900912791
Hospital Revenue Code	310
Min. Negotiated Rate	$111.65
Max. Negotiated Rate	$162.40
Rate for Payer: Cash Price	$91.35
Rate for Payer: Cigna of CA HMO/PPO	$162.40
Rate for Payer: Health Smart Auto/Commercial	$121.80
Rate for Payer: LLUH Dept of Risk Management WC	$111.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$152.25

HC LAB REF TISSUE CULTURE NEO SOLID TUMOR

Facility

$237.00

Service Code	CPT 88239
Hospital Charge Code	900912792
Hospital Revenue Code	310
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 LAB REF TISSUE CULTURE NEO SOLID TUMOR

Facility

$237.00

Service Code	CPT 88239
Hospital Charge Code	900912792
Hospital Revenue Code	310
Min. Negotiated Rate	$130.35
Max. Negotiated Rate	$177.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$142.20
Rate for Payer: Aetna of CA Government/Medicare	$142.20
Rate for Payer: Cash Price	$106.65
Rate for Payer: Health Smart Auto/Commercial	$142.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$142.20
Rate for Payer: LLUH Dept of Risk Management WC	$130.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$177.75

HC LAB REF TISSUE CULTURE NEO SOLID TUMOR

Facility

$237.00

Service Code	CPT 88239 90
Hospital Charge Code	900912792
Hospital Revenue Code	310
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 LAB REF TISSUE CULTURE NEO SOLID TUMOR

Facility

$237.00

Service Code	CPT 88239 90
Hospital Charge Code	900912792
Hospital Revenue Code	310
Min. Negotiated Rate	$130.35
Max. Negotiated Rate	$177.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$142.20
Rate for Payer: Aetna of CA Government/Medicare	$142.20
Rate for Payer: Cash Price	$106.65
Rate for Payer: Health Smart Auto/Commercial	$142.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$142.20
Rate for Payer: LLUH Dept of Risk Management WC	$130.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$177.75

HC LAB REF TISSUE CULTURE SKIN/SOLID TISS

Facility

$151.00

Service Code	CPT 88233
Hospital Charge Code	900912790
Hospital Revenue Code	310
Min. Negotiated Rate	$83.05
Max. Negotiated Rate	$113.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$90.60
Rate for Payer: Aetna of CA Government/Medicare	$90.60
Rate for Payer: Cash Price	$67.95
Rate for Payer: Health Smart Auto/Commercial	$90.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$90.60
Rate for Payer: LLUH Dept of Risk Management WC	$83.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$113.25

HC LAB REF TISSUE CULTURE SKIN/SOLID TISS

Facility

$151.00

Service Code	CPT 88233 90
Hospital Charge Code	900912790
Hospital Revenue Code	310
Min. Negotiated Rate	$83.05
Max. Negotiated Rate	$113.25
Rate for Payer: Health Smart Auto/Commercial	$90.60
Rate for Payer: Cash Price	$67.95
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$90.60
Rate for Payer: Aetna of CA Government/Medicare	$90.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$90.60
Rate for Payer: LLUH Dept of Risk Management WC	$83.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$113.25

HC LAB REF TISSUE CULTURE SKIN/SOLID TISS

Facility

$151.00

Service Code	CPT 88233
Hospital Charge Code	900912790
Hospital Revenue Code	310
Min. Negotiated Rate	$83.05
Max. Negotiated Rate	$120.80
Rate for Payer: Cash Price	$67.95
Rate for Payer: Cigna of CA HMO/PPO	$120.80
Rate for Payer: Health Smart Auto/Commercial	$90.60
Rate for Payer: LLUH Dept of Risk Management WC	$83.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$113.25

HC LAB REF TISSUE CULTURE SKIN/SOLID TISS

Facility

$151.00

Service Code	CPT 88233 90
Hospital Charge Code	900912790
Hospital Revenue Code	310
Min. Negotiated Rate	$83.05
Max. Negotiated Rate	$120.80
Rate for Payer: Cash Price	$67.95
Rate for Payer: Cigna of CA HMO/PPO	$120.80
Rate for Payer: Health Smart Auto/Commercial	$90.60
Rate for Payer: LLUH Dept of Risk Management WC	$83.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$113.25

HC LAB REF TISSUE INSITU INTERP & REPORT

Facility

$54.00

Service Code	CPT 88365 TC
Hospital Charge Code	900910703
Hospital Revenue Code	310
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$43.20
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cigna of CA HMO/PPO	$43.20
Rate for Payer: Health Smart Auto/Commercial	$32.40
Rate for Payer: LLUH Dept of Risk Management WC	$29.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$40.50

HC LAB REF TISSUE INSITU INTERP & REPORT

Facility

$54.00

Service Code	CPT 88365 TC
Hospital Charge Code	900910703
Hospital Revenue Code	310
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$40.50
Rate for Payer: Health Smart Auto/Commercial	$32.40
Rate for Payer: Cash Price	$24.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$32.40
Rate for Payer: Aetna of CA Government/Medicare	$32.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$32.40
Rate for Payer: LLUH Dept of Risk Management WC	$29.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$40.50

HC LAB REF TISSUE INSITU INTERP & REPORT

Facility

$54.00

Service Code	CPT 88365
Hospital Charge Code	900910703
Hospital Revenue Code	310
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$32.40
Rate for Payer: Aetna of CA Government/Medicare	$32.40
Rate for Payer: Cash Price	$24.30
Rate for Payer: Health Smart Auto/Commercial	$32.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$32.40
Rate for Payer: LLUH Dept of Risk Management WC	$29.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$40.50

Know your out-of-pocket cost for care.

All Charges