Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC TISS CUL NON-NEO AMNIO/CHOR

Facility

$297.00

Service Code	CPT 88235
Hospital Charge Code	900918004
Hospital Revenue Code	310
Min. Negotiated Rate	$163.35
Max. Negotiated Rate	$222.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$178.20
Rate for Payer: Aetna of CA Government/Medicare	$178.20
Rate for Payer: Cash Price	$133.65
Rate for Payer: Health Smart Auto/Commercial	$178.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$178.20
Rate for Payer: LLUH Dept of Risk Management WC	$163.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$222.75

HC TISS CUL NON-NEO AMNIO/CHOR

Facility

$412.00

Service Code	CPT 88235
Hospital Charge Code	900918004
Hospital Revenue Code	310
Min. Negotiated Rate	$226.60
Max. Negotiated Rate	$329.60
Rate for Payer: Cash Price	$185.40
Rate for Payer: Cigna of CA HMO/PPO	$329.60
Rate for Payer: Health Smart Auto/Commercial	$247.20
Rate for Payer: LLUH Dept of Risk Management WC	$226.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$309.00

HC TISS CUL NON-NEO LYMPHOCYTE

Facility

$297.00

Service Code	CPT 88230
Hospital Charge Code	900918006
Hospital Revenue Code	310
Min. Negotiated Rate	$163.35
Max. Negotiated Rate	$222.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$178.20
Rate for Payer: Aetna of CA Government/Medicare	$178.20
Rate for Payer: Cash Price	$133.65
Rate for Payer: Health Smart Auto/Commercial	$178.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$178.20
Rate for Payer: LLUH Dept of Risk Management WC	$163.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$222.75

HC TISS CUL NON-NEO LYMPHOCYTE

Facility

$412.00

Service Code	CPT 88230
Hospital Charge Code	900918006
Hospital Revenue Code	310
Min. Negotiated Rate	$226.60
Max. Negotiated Rate	$329.60
Rate for Payer: Cash Price	$185.40
Rate for Payer: Cigna of CA HMO/PPO	$329.60
Rate for Payer: Health Smart Auto/Commercial	$247.20
Rate for Payer: LLUH Dept of Risk Management WC	$226.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$309.00

HC TISS CUL NON-NEO SKN/OTH BX

Facility

$297.00

Service Code	CPT 88233
Hospital Charge Code	900918005
Hospital Revenue Code	310
Min. Negotiated Rate	$163.35
Max. Negotiated Rate	$222.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$178.20
Rate for Payer: Aetna of CA Government/Medicare	$178.20
Rate for Payer: Cash Price	$133.65
Rate for Payer: Health Smart Auto/Commercial	$178.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$178.20
Rate for Payer: LLUH Dept of Risk Management WC	$163.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$222.75

HC TISS CUL NON-NEO SKN/OTH BX

Facility

$412.00

Service Code	CPT 88233
Hospital Charge Code	900918005
Hospital Revenue Code	310
Min. Negotiated Rate	$226.60
Max. Negotiated Rate	$329.60
Rate for Payer: Cash Price	$185.40
Rate for Payer: Cigna of CA HMO/PPO	$329.60
Rate for Payer: Health Smart Auto/Commercial	$247.20
Rate for Payer: LLUH Dept of Risk Management WC	$226.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$309.00

HC TISSUE HOMOGENIZATION, CULTR

Facility

$22.00

Service Code	CPT 87176
Hospital Charge Code	900911804
Hospital Revenue Code	306
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.20
Rate for Payer: Aetna of CA Government/Medicare	$13.20
Rate for Payer: Cash Price	$9.90
Rate for Payer: Health Smart Auto/Commercial	$13.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.20
Rate for Payer: LLUH Dept of Risk Management WC	$12.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.50

HC TISSUE HOMOGENIZATION, CULTR

Facility

$129.00

Service Code	CPT 87176
Hospital Charge Code	900911804
Hospital Revenue Code	306
Min. Negotiated Rate	$70.95
Max. Negotiated Rate	$103.20
Rate for Payer: Cash Price	$58.05
Rate for Payer: Cigna of CA HMO/PPO	$103.20
Rate for Payer: Health Smart Auto/Commercial	$77.40
Rate for Payer: LLUH Dept of Risk Management WC	$70.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$96.75

HC TOBRAMYCIN

Facility

$223.00

Service Code	CPT 80200
Hospital Charge Code	900910408
Hospital Revenue Code	301
Min. Negotiated Rate	$122.65
Max. Negotiated Rate	$178.40
Rate for Payer: Cash Price	$100.35
Rate for Payer: Cigna of CA HMO/PPO	$178.40
Rate for Payer: Health Smart Auto/Commercial	$133.80
Rate for Payer: LLUH Dept of Risk Management WC	$122.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$167.25

HC TOBRAMYCIN

Facility

$50.00

Service Code	CPT 80200
Hospital Charge Code	900910408
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.50

HC TOES

Facility

$666.00

Service Code	CPT 73660
Hospital Charge Code	909001634
Hospital Revenue Code	320
Min. Negotiated Rate	$366.30
Max. Negotiated Rate	$532.80
Rate for Payer: Cash Price	$299.70
Rate for Payer: Cigna of CA HMO/PPO	$532.80
Rate for Payer: Health Smart Auto/Commercial	$399.60
Rate for Payer: LLUH Dept of Risk Management WC	$366.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$499.50

HC TOES

Facility

$666.00

Service Code	CPT 73660 TC
Hospital Charge Code	909001634
Hospital Revenue Code	320
Min. Negotiated Rate	$366.30
Max. Negotiated Rate	$532.80
Rate for Payer: Cash Price	$299.70
Rate for Payer: Cigna of CA HMO/PPO	$532.80
Rate for Payer: Health Smart Auto/Commercial	$399.60
Rate for Payer: LLUH Dept of Risk Management WC	$366.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$499.50

HC TOES

Facility

$666.00

Service Code	CPT 73660
Hospital Charge Code	909001634
Hospital Revenue Code	320
Min. Negotiated Rate	$366.30
Max. Negotiated Rate	$499.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$399.60
Rate for Payer: Aetna of CA Government/Medicare	$399.60
Rate for Payer: Cash Price	$299.70
Rate for Payer: Health Smart Auto/Commercial	$399.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$399.60
Rate for Payer: LLUH Dept of Risk Management WC	$366.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$499.50

HC TOES

Facility

$666.00

Service Code	CPT 73660 TC
Hospital Charge Code	909001634
Hospital Revenue Code	320
Min. Negotiated Rate	$366.30
Max. Negotiated Rate	$499.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$399.60
Rate for Payer: Aetna of CA Government/Medicare	$399.60
Rate for Payer: Cash Price	$299.70
Rate for Payer: Health Smart Auto/Commercial	$399.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$399.60
Rate for Payer: LLUH Dept of Risk Management WC	$366.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$499.50

HC TOXOPLASMA AB IGG

Facility

$210.00

Service Code	CPT 86777
Hospital Charge Code	900910989
Hospital Revenue Code	302
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$168.00
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cigna of CA HMO/PPO	$168.00
Rate for Payer: Health Smart Auto/Commercial	$126.00
Rate for Payer: LLUH Dept of Risk Management WC	$115.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$157.50

HC TOXOPLASMA AB IGG

Facility

$55.00

Service Code	CPT 86777
Hospital Charge Code	900910989
Hospital Revenue Code	302
Min. Negotiated Rate	$30.25
Max. Negotiated Rate	$41.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$33.00
Rate for Payer: Aetna of CA Government/Medicare	$33.00
Rate for Payer: Cash Price	$24.75
Rate for Payer: Health Smart Auto/Commercial	$33.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$33.00
Rate for Payer: LLUH Dept of Risk Management WC	$30.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$41.25

HC TOXOPLASMA AB IGM

Facility

$55.00

Service Code	CPT 86778
Hospital Charge Code	900912320
Hospital Revenue Code	306
Min. Negotiated Rate	$30.25
Max. Negotiated Rate	$41.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$33.00
Rate for Payer: Aetna of CA Government/Medicare	$33.00
Rate for Payer: Cash Price	$24.75
Rate for Payer: Health Smart Auto/Commercial	$33.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$33.00
Rate for Payer: LLUH Dept of Risk Management WC	$30.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$41.25

HC TOXOPLASMA AB IGM

Facility

$210.00

Service Code	CPT 86778
Hospital Charge Code	900912320
Hospital Revenue Code	306
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$168.00
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cigna of CA HMO/PPO	$168.00
Rate for Payer: Health Smart Auto/Commercial	$126.00
Rate for Payer: LLUH Dept of Risk Management WC	$115.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$157.50

HC TOXOPLASMA ANTIBODY IGG

Facility

$58.00

Service Code	CPT 86777
Hospital Charge Code	900913667
Hospital Revenue Code	302
Min. Negotiated Rate	$31.90
Max. Negotiated Rate	$46.40
Rate for Payer: Cash Price	$26.10
Rate for Payer: Cigna of CA HMO/PPO	$46.40
Rate for Payer: Health Smart Auto/Commercial	$34.80
Rate for Payer: LLUH Dept of Risk Management WC	$31.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$43.50

HC TOXOPLASMA ANTIBODY IGG

Facility

$39.00

Service Code	CPT 86777
Hospital Charge Code	900913667
Hospital Revenue Code	302
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 TOXOPLASMA ANTIBODY IGM

Facility

$39.00

Service Code	CPT 86778
Hospital Charge Code	900913668
Hospital Revenue Code	302
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 TOXOPLASMA ANTIBODY IGM

Facility

$58.00

Service Code	CPT 86778
Hospital Charge Code	900913668
Hospital Revenue Code	302
Min. Negotiated Rate	$31.90
Max. Negotiated Rate	$46.40
Rate for Payer: Cash Price	$26.10
Rate for Payer: Cigna of CA HMO/PPO	$46.40
Rate for Payer: Health Smart Auto/Commercial	$34.80
Rate for Payer: LLUH Dept of Risk Management WC	$31.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$43.50

HC TRANSFERRIN

Facility

$216.00

Service Code	CPT 84466
Hospital Charge Code	900910854
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 TRANSFERRIN

Facility

$49.00

Service Code	CPT 84466
Hospital Charge Code	900910854
Hospital Revenue Code	301
Min. Negotiated Rate	$26.95
Max. Negotiated Rate	$36.75
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: Health Smart Auto/Commercial	$29.40
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 Beech St/Commercial/PHCS	$36.75

HC TRANSGLUTAMINASE IGA AB

Facility

$44.00

Service Code	CPT 83516
Hospital Charge Code	900913555
Hospital Revenue Code	302
Min. Negotiated Rate	$24.20
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$26.40
Rate for Payer: Aetna of CA Government/Medicare	$26.40
Rate for Payer: Cash Price	$19.80
Rate for Payer: Health Smart Auto/Commercial	$26.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$26.40
Rate for Payer: LLUH Dept of Risk Management WC	$24.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.00

Know your out-of-pocket cost for care.

All Charges