Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC LAB REF ALCOHOL METHYL

Facility

$79.00

Service Code	CPT 80320
Hospital Charge Code	900910716
Hospital Revenue Code	301
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$63.20
Rate for Payer: Cash Price	$35.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$63.20
Rate for Payer: Health Smart Auto/Commercial	$47.40
Rate for Payer: LLUH Dept of Risk Management WC	$43.45
Rate for Payer: Multiplan Commercial	$59.25

HC LAB REF ALLERGEN INDIVIDUAL (RAST)

Facility

$8.00

Service Code	CPT 86003
Hospital Charge Code	900911010
Hospital Revenue Code	302
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$6.40
Rate for Payer: Cash Price	$3.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.40
Rate for Payer: Health Smart Auto/Commercial	$4.80
Rate for Payer: LLUH Dept of Risk Management WC	$4.40
Rate for Payer: Multiplan Commercial	$6.00

HC LAB REF ALLERGEN INDIVIDUAL (RAST)

Facility

$8.00

Service Code	CPT 86003
Hospital Charge Code	900911010
Hospital Revenue Code	302
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$6.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.80
Rate for Payer: Aetna of CA Government/Medicare	$4.80
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$3.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.40
Rate for Payer: Health Smart Auto/Commercial	$4.80
Rate for Payer: Intervalley Health Plan Commercial	$5.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.80
Rate for Payer: LLUH Dept of Risk Management WC	$4.40
Rate for Payer: Multiplan Commercial	$6.00

HC LAB REF ALPHA 2 ANTIPLASMIN

Facility

$12.00

Service Code	CPT 85410
Hospital Charge Code	900910717
Hospital Revenue Code	305
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.20
Rate for Payer: Aetna of CA Government/Medicare	$7.20
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cash Price	$5.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$9.60
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: Intervalley Health Plan Commercial	$7.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Commercial	$9.00

HC LAB REF ALPHA 2 ANTIPLASMIN

Facility

$12.00

Service Code	CPT 85410
Hospital Charge Code	900910717
Hospital Revenue Code	305
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.60
Rate for Payer: Cash Price	$5.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$9.60
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Commercial	$9.00

HC LAB REF AMPHOTERICIN B

Facility

$101.00

Service Code	CPT 84999
Hospital Charge Code	900911105
Hospital Revenue Code	301
Min. Negotiated Rate	$55.55
Max. Negotiated Rate	$80.80
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: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$80.80
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 Commercial	$75.75

HC LAB REF AMPHOTERICIN B

Facility

$101.00

Service Code	CPT 84999
Hospital Charge Code	900911105
Hospital Revenue Code	301
Min. Negotiated Rate	$55.55
Max. Negotiated Rate	$80.80
Rate for Payer: Cash Price	$45.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$75.75

HC LAB REF AMPICILIIN

Facility

$25.00

Service Code	CPT 80299
Hospital Charge Code	900911154
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.00
Rate for Payer: Aetna of CA Government/Medicare	$15.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Cash Price	$11.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$20.00
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: Intervalley Health Plan Commercial	$18.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Commercial	$18.75

HC LAB REF AMPICILIIN

Facility

$25.00

Service Code	CPT 80299
Hospital Charge Code	900911154
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$20.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$20.00
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Commercial	$18.75

HC LAB REF ANTI-EPITHELIAL AB

Facility

$19.00

Service Code	CPT 86256
Hospital Charge Code	900911410
Hospital Revenue Code	302
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$15.20
Rate for Payer: Cash Price	$8.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$15.20
Rate for Payer: Health Smart Auto/Commercial	$11.40
Rate for Payer: LLUH Dept of Risk Management WC	$10.45
Rate for Payer: Multiplan Commercial	$14.25

HC LAB REF ANTI-EPITHELIAL AB

Facility

$19.00

Service Code	CPT 86256
Hospital Charge Code	900911410
Hospital Revenue Code	302
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$15.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.40
Rate for Payer: Aetna of CA Government/Medicare	$11.40
Rate for Payer: Cash Price	$8.55
Rate for Payer: Cash Price	$8.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$15.20
Rate for Payer: Health Smart Auto/Commercial	$11.40
Rate for Payer: Intervalley Health Plan Commercial	$12.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.40
Rate for Payer: LLUH Dept of Risk Management WC	$10.45
Rate for Payer: Multiplan Commercial	$14.25

HC LAB REF ANTIMONY

Facility

$70.00

Service Code	CPT 83018
Hospital Charge Code	900911078
Hospital Revenue Code	301
Min. Negotiated Rate	$21.96
Max. Negotiated Rate	$56.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$42.00
Rate for Payer: Aetna of CA Government/Medicare	$42.00
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cash Price	$31.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$56.00
Rate for Payer: Health Smart Auto/Commercial	$42.00
Rate for Payer: Intervalley Health Plan Commercial	$21.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$42.00
Rate for Payer: LLUH Dept of Risk Management WC	$38.50
Rate for Payer: Multiplan Commercial	$52.50

HC LAB REF ANTIMONY

Facility

$70.00

Service Code	CPT 83018
Hospital Charge Code	900911078
Hospital Revenue Code	301
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$56.00
Rate for Payer: Cash Price	$31.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$56.00
Rate for Payer: Health Smart Auto/Commercial	$42.00
Rate for Payer: LLUH Dept of Risk Management WC	$38.50
Rate for Payer: Multiplan Commercial	$52.50

HC LAB REF ANTI-PM1 AB

Facility

$101.00

Service Code	CPT 86235
Hospital Charge Code	900911424
Hospital Revenue Code	302
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$80.80
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: Cash Price	$45.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$80.80
Rate for Payer: Health Smart Auto/Commercial	$60.60
Rate for Payer: Intervalley Health Plan Commercial	$17.93
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 Commercial	$75.75

HC LAB REF ANTI-PM1 AB

Facility

$101.00

Service Code	CPT 86235
Hospital Charge Code	900911424
Hospital Revenue Code	302
Min. Negotiated Rate	$55.55
Max. Negotiated Rate	$80.80
Rate for Payer: Cash Price	$45.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$75.75

HC LAB REF ARYLSULFATASE A FIBROBLASTS

Facility

$341.00

Service Code	CPT 82657
Hospital Charge Code	900910564
Hospital Revenue Code	301
Min. Negotiated Rate	$22.17
Max. Negotiated Rate	$272.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$204.60
Rate for Payer: Aetna of CA Government/Medicare	$204.60
Rate for Payer: Cash Price	$153.45
Rate for Payer: Cash Price	$153.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$272.80
Rate for Payer: Health Smart Auto/Commercial	$204.60
Rate for Payer: Intervalley Health Plan Commercial	$22.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$204.60
Rate for Payer: LLUH Dept of Risk Management WC	$187.55
Rate for Payer: Multiplan Commercial	$255.75

HC LAB REF ARYLSULFATASE A FIBROBLASTS

Facility

$341.00

Service Code	CPT 82657
Hospital Charge Code	900910564
Hospital Revenue Code	301
Min. Negotiated Rate	$187.55
Max. Negotiated Rate	$272.80
Rate for Payer: Cash Price	$153.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$272.80
Rate for Payer: Health Smart Auto/Commercial	$204.60
Rate for Payer: LLUH Dept of Risk Management WC	$187.55
Rate for Payer: Multiplan Commercial	$255.75

HC LAB REF ASPERGILLUS AB

Facility

$45.00

Service Code	CPT 86606
Hospital Charge Code	900911117
Hospital Revenue Code	302
Min. Negotiated Rate	$15.05
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.00
Rate for Payer: Aetna of CA Government/Medicare	$27.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Cash Price	$20.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$36.00
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: Intervalley Health Plan Commercial	$15.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Commercial	$33.75

HC LAB REF ASPERGILLUS AB

Facility

$45.00

Service Code	CPT 86606
Hospital Charge Code	900911117
Hospital Revenue Code	302
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$36.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$36.00
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Commercial	$33.75

HC LAB REF BIOTINADASE

Facility

$27.00

Service Code	CPT 82261
Hospital Charge Code	900910727
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$21.60
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: LLUH Dept of Risk Management WC	$14.85
Rate for Payer: Multiplan Commercial	$20.25

HC LAB REF BIOTINADASE

Facility

$27.00

Service Code	CPT 82261
Hospital Charge Code	900910727
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
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	$16.87
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 LAB REF BK VIRUS BY PCR

Facility

$56.00

Service Code	CPT 87798
Hospital Charge Code	900912606
Hospital Revenue Code	306
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$44.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$33.60
Rate for Payer: Aetna of CA Government/Medicare	$33.60
Rate for Payer: Cash Price	$25.20
Rate for Payer: Cash Price	$25.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$44.80
Rate for Payer: Health Smart Auto/Commercial	$33.60
Rate for Payer: Intervalley Health Plan Commercial	$35.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$33.60
Rate for Payer: LLUH Dept of Risk Management WC	$30.80
Rate for Payer: Multiplan Commercial	$42.00

HC LAB REF BK VIRUS BY PCR

Facility

$56.00

Service Code	CPT 87798
Hospital Charge Code	900912606
Hospital Revenue Code	306
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$44.80
Rate for Payer: Cash Price	$25.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$44.80
Rate for Payer: Health Smart Auto/Commercial	$33.60
Rate for Payer: LLUH Dept of Risk Management WC	$30.80
Rate for Payer: Multiplan Commercial	$42.00

HC LAB REF BK VIRUS QUANT PCR, URINE

Facility

$69.00

Service Code	CPT 87799
Hospital Charge Code	900912695
Hospital Revenue Code	301
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$55.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$41.40
Rate for Payer: Aetna of CA Government/Medicare	$41.40
Rate for Payer: Cash Price	$31.05
Rate for Payer: Cash Price	$31.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$55.20
Rate for Payer: Health Smart Auto/Commercial	$41.40
Rate for Payer: Intervalley Health Plan Commercial	$42.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$41.40
Rate for Payer: LLUH Dept of Risk Management WC	$37.95
Rate for Payer: Multiplan Commercial	$51.75

HC LAB REF BK VIRUS QUANT PCR, URINE

Facility

$69.00

Service Code	CPT 87799
Hospital Charge Code	900912695
Hospital Revenue Code	301
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$55.20
Rate for Payer: Cash Price	$31.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$55.20
Rate for Payer: Health Smart Auto/Commercial	$41.40
Rate for Payer: LLUH Dept of Risk Management WC	$37.95
Rate for Payer: Multiplan Commercial	$51.75

Know your out-of-pocket cost for care.

All Charges