Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC TISS CUL NEO SOLID TUMOR

Facility

$295.00

Service Code	CPT 88239
Hospital Charge Code	900918002
Hospital Revenue Code	310
Min. Negotiated Rate	$147.52
Max. Negotiated Rate	$236.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$177.00
Rate for Payer: Aetna of CA Government/Medicare	$177.00
Rate for Payer: Cash Price	$132.75
Rate for Payer: Cash Price	$132.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$236.00
Rate for Payer: Health Smart Auto/Commercial	$177.00
Rate for Payer: Intervalley Health Plan Commercial	$147.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$177.00
Rate for Payer: LLUH Dept of Risk Management WC	$162.25
Rate for Payer: Multiplan Commercial	$221.25

HC TISS CUL NEO SOLID TUMOR

Facility

$410.00

Service Code	CPT 88239
Hospital Charge Code	900918002
Hospital Revenue Code	310
Min. Negotiated Rate	$225.50
Max. Negotiated Rate	$328.00
Rate for Payer: Cash Price	$184.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$328.00
Rate for Payer: Health Smart Auto/Commercial	$246.00
Rate for Payer: LLUH Dept of Risk Management WC	$225.50
Rate for Payer: Multiplan Commercial	$307.50

HC TISS CUL NON-NEO AMNIO/CHOR

Facility

$403.00

Service Code	CPT 88235
Hospital Charge Code	900918004
Hospital Revenue Code	310
Min. Negotiated Rate	$221.65
Max. Negotiated Rate	$322.40
Rate for Payer: Cash Price	$181.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$322.40
Rate for Payer: Health Smart Auto/Commercial	$241.80
Rate for Payer: LLUH Dept of Risk Management WC	$221.65
Rate for Payer: Multiplan Commercial	$302.25

HC TISS CUL NON-NEO AMNIO/CHOR

Facility

$291.00

Service Code	CPT 88235
Hospital Charge Code	900918004
Hospital Revenue Code	310
Min. Negotiated Rate	$150.30
Max. Negotiated Rate	$232.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$174.60
Rate for Payer: Aetna of CA Government/Medicare	$174.60
Rate for Payer: Cash Price	$130.95
Rate for Payer: Cash Price	$130.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$232.80
Rate for Payer: Health Smart Auto/Commercial	$174.60
Rate for Payer: Intervalley Health Plan Commercial	$150.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$174.60
Rate for Payer: LLUH Dept of Risk Management WC	$160.05
Rate for Payer: Multiplan Commercial	$218.25

HC TISS CUL NON-NEO LYMPHOCYTE

Facility

$684.00

Service Code	CPT 88230
Hospital Charge Code	900918006
Hospital Revenue Code	310
Min. Negotiated Rate	$116.49
Max. Negotiated Rate	$547.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$410.40
Rate for Payer: Aetna of CA Government/Medicare	$410.40
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$547.20
Rate for Payer: Health Smart Auto/Commercial	$410.40
Rate for Payer: Intervalley Health Plan Commercial	$116.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$410.40
Rate for Payer: LLUH Dept of Risk Management WC	$376.20
Rate for Payer: Multiplan Commercial	$513.00

HC TISS CUL NON-NEO LYMPHOCYTE

Facility

$948.00

Service Code	CPT 88230
Hospital Charge Code	900918006
Hospital Revenue Code	310
Min. Negotiated Rate	$521.40
Max. Negotiated Rate	$758.40
Rate for Payer: Cash Price	$426.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$758.40
Rate for Payer: Health Smart Auto/Commercial	$568.80
Rate for Payer: LLUH Dept of Risk Management WC	$521.40
Rate for Payer: Multiplan Commercial	$711.00

HC TISS CUL NON-NEO SKN/OTH BX

Facility

$403.00

Service Code	CPT 88233
Hospital Charge Code	900918005
Hospital Revenue Code	310
Min. Negotiated Rate	$221.65
Max. Negotiated Rate	$322.40
Rate for Payer: Cash Price	$181.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$322.40
Rate for Payer: Health Smart Auto/Commercial	$241.80
Rate for Payer: LLUH Dept of Risk Management WC	$221.65
Rate for Payer: Multiplan Commercial	$302.25

HC TISS CUL NON-NEO SKN/OTH BX

Facility

$291.00

Service Code	CPT 88233
Hospital Charge Code	900918005
Hospital Revenue Code	310
Min. Negotiated Rate	$140.73
Max. Negotiated Rate	$232.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$174.60
Rate for Payer: Aetna of CA Government/Medicare	$174.60
Rate for Payer: Cash Price	$130.95
Rate for Payer: Cash Price	$130.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$232.80
Rate for Payer: Health Smart Auto/Commercial	$174.60
Rate for Payer: Intervalley Health Plan Commercial	$140.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$174.60
Rate for Payer: LLUH Dept of Risk Management WC	$160.05
Rate for Payer: Multiplan Commercial	$218.25

HC TISSUE HOMOGENIZATION, CULTR

Facility

$126.00

Service Code	CPT 87176
Hospital Charge Code	900911804
Hospital Revenue Code	306
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$100.80
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: LLUH Dept of Risk Management WC	$69.30
Rate for Payer: Multiplan Commercial	$94.50

HC TISSUE HOMOGENIZATION, CULTR

Facility

$27.00

Service Code	CPT 87176
Hospital Charge Code	900911804
Hospital Revenue Code	306
Min. Negotiated Rate	$5.88
Max. Negotiated Rate	$21.60
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: Cash Price	$12.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$21.60
Rate for Payer: Health Smart Auto/Commercial	$16.20
Rate for Payer: Intervalley Health Plan Commercial	$5.88
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 Commercial	$20.25

HC TOBRAMYCIN

Facility

$49.00

Service Code	CPT 80200
Hospital Charge Code	900910408
Hospital Revenue Code	301
Min. Negotiated Rate	$16.13
Max. Negotiated Rate	$39.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$29.40
Rate for Payer: Aetna of CA Government/Medicare	$29.40
Rate for Payer: Cash Price	$22.05
Rate for Payer: Cash Price	$22.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$39.20
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: Intervalley Health Plan Commercial	$16.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$29.40
Rate for Payer: LLUH Dept of Risk Management WC	$26.95
Rate for Payer: Multiplan Commercial	$36.75

HC TOBRAMYCIN

Facility

$218.00

Service Code	CPT 80200
Hospital Charge Code	900910408
Hospital Revenue Code	301
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$174.40
Rate for Payer: Cash Price	$98.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$163.50

HC TOES

Facility

$740.00

Service Code	CPT 73660
Hospital Charge Code	909001634
Hospital Revenue Code	320
Min. Negotiated Rate	$407.00
Max. Negotiated Rate	$592.00
Rate for Payer: Cash Price	$333.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$592.00
Rate for Payer: Health Smart Auto/Commercial	$444.00
Rate for Payer: LLUH Dept of Risk Management WC	$407.00
Rate for Payer: Multiplan Commercial	$555.00

HC TOES

Facility

$740.00

Service Code	CPT 73660
Hospital Charge Code	909001634
Hospital Revenue Code	320
Min. Negotiated Rate	$407.00
Max. Negotiated Rate	$592.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$444.00
Rate for Payer: Aetna of CA Government/Medicare	$444.00
Rate for Payer: Cash Price	$333.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$592.00
Rate for Payer: Health Smart Auto/Commercial	$444.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$444.00
Rate for Payer: LLUH Dept of Risk Management WC	$407.00
Rate for Payer: Multiplan Commercial	$555.00

HC TOXOPLASMA AB IGG

Facility

$130.00

Service Code	CPT 86777
Hospital Charge Code	900910989
Hospital Revenue Code	302
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$104.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$78.00
Rate for Payer: Aetna of CA Government/Medicare	$78.00
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$104.00
Rate for Payer: Health Smart Auto/Commercial	$78.00
Rate for Payer: Intervalley Health Plan Commercial	$14.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$78.00
Rate for Payer: LLUH Dept of Risk Management WC	$71.50
Rate for Payer: Multiplan Commercial	$97.50

HC TOXOPLASMA AB IGG

Facility

$278.00

Service Code	CPT 86777
Hospital Charge Code	900910989
Hospital Revenue Code	302
Min. Negotiated Rate	$152.90
Max. Negotiated Rate	$222.40
Rate for Payer: Cash Price	$125.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$222.40
Rate for Payer: Health Smart Auto/Commercial	$166.80
Rate for Payer: LLUH Dept of Risk Management WC	$152.90
Rate for Payer: Multiplan Commercial	$208.50

HC TOXOPLASMA AB IGM

Facility

$278.00

Service Code	CPT 86778
Hospital Charge Code	900912320
Hospital Revenue Code	306
Min. Negotiated Rate	$152.90
Max. Negotiated Rate	$222.40
Rate for Payer: Cash Price	$125.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$222.40
Rate for Payer: Health Smart Auto/Commercial	$166.80
Rate for Payer: LLUH Dept of Risk Management WC	$152.90
Rate for Payer: Multiplan Commercial	$208.50

HC TOXOPLASMA AB IGM

Facility

$130.00

Service Code	CPT 86778
Hospital Charge Code	900912320
Hospital Revenue Code	306
Min. Negotiated Rate	$14.41
Max. Negotiated Rate	$104.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$78.00
Rate for Payer: Aetna of CA Government/Medicare	$78.00
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$104.00
Rate for Payer: Health Smart Auto/Commercial	$78.00
Rate for Payer: Intervalley Health Plan Commercial	$14.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$78.00
Rate for Payer: LLUH Dept of Risk Management WC	$71.50
Rate for Payer: Multiplan Commercial	$97.50

HC TOXOPLASMA ANTIBODY IGG

Facility

$134.00

Service Code	CPT 86777
Hospital Charge Code	900913667
Hospital Revenue Code	302
Min. Negotiated Rate	$73.70
Max. Negotiated Rate	$107.20
Rate for Payer: Cash Price	$60.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$107.20
Rate for Payer: Health Smart Auto/Commercial	$80.40
Rate for Payer: LLUH Dept of Risk Management WC	$73.70
Rate for Payer: Multiplan Commercial	$100.50

HC TOXOPLASMA ANTIBODY IGG

Facility

$98.00

Service Code	CPT 86777
Hospital Charge Code	900913667
Hospital Revenue Code	302
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$78.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$58.80
Rate for Payer: Aetna of CA Government/Medicare	$58.80
Rate for Payer: Cash Price	$44.10
Rate for Payer: Cash Price	$44.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$78.40
Rate for Payer: Health Smart Auto/Commercial	$58.80
Rate for Payer: Intervalley Health Plan Commercial	$14.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$58.80
Rate for Payer: LLUH Dept of Risk Management WC	$53.90
Rate for Payer: Multiplan Commercial	$73.50

HC TOXOPLASMA ANTIBODY IGM

Facility

$98.00

Service Code	CPT 86778
Hospital Charge Code	900913668
Hospital Revenue Code	302
Min. Negotiated Rate	$14.41
Max. Negotiated Rate	$78.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$58.80
Rate for Payer: Aetna of CA Government/Medicare	$58.80
Rate for Payer: Cash Price	$44.10
Rate for Payer: Cash Price	$44.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$78.40
Rate for Payer: Health Smart Auto/Commercial	$58.80
Rate for Payer: Intervalley Health Plan Commercial	$14.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$58.80
Rate for Payer: LLUH Dept of Risk Management WC	$53.90
Rate for Payer: Multiplan Commercial	$73.50

HC TOXOPLASMA ANTIBODY IGM

Facility

$134.00

Service Code	CPT 86778
Hospital Charge Code	900913668
Hospital Revenue Code	302
Min. Negotiated Rate	$73.70
Max. Negotiated Rate	$107.20
Rate for Payer: Cash Price	$60.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$107.20
Rate for Payer: Health Smart Auto/Commercial	$80.40
Rate for Payer: LLUH Dept of Risk Management WC	$73.70
Rate for Payer: Multiplan Commercial	$100.50

HC TRANSFERRIN

Facility

$239.00

Service Code	CPT 84466
Hospital Charge Code	900910854
Hospital Revenue Code	301
Min. Negotiated Rate	$131.45
Max. Negotiated Rate	$191.20
Rate for Payer: Cash Price	$107.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$191.20
Rate for Payer: Health Smart Auto/Commercial	$143.40
Rate for Payer: LLUH Dept of Risk Management WC	$131.45
Rate for Payer: Multiplan Commercial	$179.25

HC TRANSFERRIN

Facility

$108.00

Service Code	CPT 84466
Hospital Charge Code	900910854
Hospital Revenue Code	301
Min. Negotiated Rate	$12.76
Max. Negotiated Rate	$86.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$64.80
Rate for Payer: Aetna of CA Government/Medicare	$64.80
Rate for Payer: Cash Price	$48.60
Rate for Payer: Cash Price	$48.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$86.40
Rate for Payer: Health Smart Auto/Commercial	$64.80
Rate for Payer: Intervalley Health Plan Commercial	$12.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$64.80
Rate for Payer: LLUH Dept of Risk Management WC	$59.40
Rate for Payer: Multiplan Commercial	$81.00

HC TRANSGLUTAMINASE IGA AB

Facility

$78.00

Service Code	CPT 83516
Hospital Charge Code	900913555
Hospital Revenue Code	302
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$62.40
Rate for Payer: Cash Price	$35.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$62.40
Rate for Payer: Health Smart Auto/Commercial	$46.80
Rate for Payer: LLUH Dept of Risk Management WC	$42.90
Rate for Payer: Multiplan Commercial	$58.50

Know your out-of-pocket cost for care.

All Charges