Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC LAB REF FIBRONECTIN IGA

Facility

$189.00

Service Code	CPT 83520
Hospital Charge Code	900911597
Hospital Revenue Code	301
Min. Negotiated Rate	$17.27
Max. Negotiated Rate	$151.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$113.40
Rate for Payer: Aetna of CA Government/Medicare	$113.40
Rate for Payer: Cash Price	$85.05
Rate for Payer: Cash Price	$85.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$151.20
Rate for Payer: Health Smart Auto/Commercial	$113.40
Rate for Payer: Intervalley Health Plan Commercial	$17.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$113.40
Rate for Payer: LLUH Dept of Risk Management WC	$103.95
Rate for Payer: Multiplan Commercial	$141.75

HC LAB REF FIBRONECTIN IGA

Facility

$189.00

Service Code	CPT 83520
Hospital Charge Code	900911597
Hospital Revenue Code	301
Min. Negotiated Rate	$103.95
Max. Negotiated Rate	$151.20
Rate for Payer: Cash Price	$85.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$151.20
Rate for Payer: Health Smart Auto/Commercial	$113.40
Rate for Payer: LLUH Dept of Risk Management WC	$103.95
Rate for Payer: Multiplan Commercial	$141.75

HC LAB REF FISH ANEUPLOIDY REFLEX, POC

Facility

$39.00

Service Code	CPT 88291
Hospital Charge Code	900912706
Hospital Revenue Code	310
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$31.20
Rate for Payer: Cash Price	$17.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$31.20
Rate for Payer: Health Smart Auto/Commercial	$23.40
Rate for Payer: LLUH Dept of Risk Management WC	$21.45
Rate for Payer: Multiplan Commercial	$29.25

HC LAB REF FISH ANEUPLOIDY REFLEX, POC

Facility

$39.00

Service Code	CPT 88291
Hospital Charge Code	900912706
Hospital Revenue Code	310
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$31.20
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: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$31.20
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 Commercial	$29.25

HC LAB REF FISH BCR/ABL FUSION

Facility

$48.00

Service Code	CPT 88291
Hospital Charge Code	900910682
Hospital Revenue Code	310
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$38.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$28.80
Rate for Payer: Aetna of CA Government/Medicare	$28.80
Rate for Payer: Cash Price	$21.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$38.40
Rate for Payer: Health Smart Auto/Commercial	$28.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$28.80
Rate for Payer: LLUH Dept of Risk Management WC	$26.40
Rate for Payer: Multiplan Commercial	$36.00

HC LAB REF FISH BCR/ABL FUSION

Facility

$48.00

Service Code	CPT 88291
Hospital Charge Code	900910682
Hospital Revenue Code	310
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$38.40
Rate for Payer: Cash Price	$21.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$38.40
Rate for Payer: Health Smart Auto/Commercial	$28.80
Rate for Payer: LLUH Dept of Risk Management WC	$26.40
Rate for Payer: Multiplan Commercial	$36.00

HC LAB REF FISH HER2/NEU FOR BREAST CANCE

Facility

$287.00

Service Code	CPT 88291
Hospital Charge Code	900910698
Hospital Revenue Code	310
Min. Negotiated Rate	$157.85
Max. Negotiated Rate	$229.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$172.20
Rate for Payer: Aetna of CA Government/Medicare	$172.20
Rate for Payer: Cash Price	$129.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$229.60
Rate for Payer: Health Smart Auto/Commercial	$172.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$172.20
Rate for Payer: LLUH Dept of Risk Management WC	$157.85
Rate for Payer: Multiplan Commercial	$215.25

HC LAB REF FISH HER2/NEU FOR BREAST CANCE

Facility

$287.00

Service Code	CPT 88291
Hospital Charge Code	900910698
Hospital Revenue Code	310
Min. Negotiated Rate	$157.85
Max. Negotiated Rate	$229.60
Rate for Payer: Cash Price	$129.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$229.60
Rate for Payer: Health Smart Auto/Commercial	$172.20
Rate for Payer: LLUH Dept of Risk Management WC	$157.85
Rate for Payer: Multiplan Commercial	$215.25

HC LAB REF FISH OPPOSITE SEX BONE MARROW

Facility

$307.00

Service Code	CPT 88291
Hospital Charge Code	900910687
Hospital Revenue Code	310
Min. Negotiated Rate	$168.85
Max. Negotiated Rate	$245.60
Rate for Payer: Cash Price	$138.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$245.60
Rate for Payer: Health Smart Auto/Commercial	$184.20
Rate for Payer: LLUH Dept of Risk Management WC	$168.85
Rate for Payer: Multiplan Commercial	$230.25

HC LAB REF FISH OPPOSITE SEX BONE MARROW

Facility

$307.00

Service Code	CPT 88291
Hospital Charge Code	900910687
Hospital Revenue Code	310
Min. Negotiated Rate	$168.85
Max. Negotiated Rate	$245.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$184.20
Rate for Payer: Aetna of CA Government/Medicare	$184.20
Rate for Payer: Cash Price	$138.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$245.60
Rate for Payer: Health Smart Auto/Commercial	$184.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$184.20
Rate for Payer: LLUH Dept of Risk Management WC	$168.85
Rate for Payer: Multiplan Commercial	$230.25

HC LAB REF FISH TELOMERIC REGIONS

Facility

$294.00

Service Code	CPT 88291
Hospital Charge Code	900910692
Hospital Revenue Code	310
Min. Negotiated Rate	$161.70
Max. Negotiated Rate	$235.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$176.40
Rate for Payer: Aetna of CA Government/Medicare	$176.40
Rate for Payer: Cash Price	$132.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$235.20
Rate for Payer: Health Smart Auto/Commercial	$176.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$176.40
Rate for Payer: LLUH Dept of Risk Management WC	$161.70
Rate for Payer: Multiplan Commercial	$220.50

HC LAB REF FISH TELOMERIC REGIONS

Facility

$294.00

Service Code	CPT 88291
Hospital Charge Code	900910692
Hospital Revenue Code	310
Min. Negotiated Rate	$161.70
Max. Negotiated Rate	$235.20
Rate for Payer: Cash Price	$132.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$235.20
Rate for Payer: Health Smart Auto/Commercial	$176.40
Rate for Payer: LLUH Dept of Risk Management WC	$161.70
Rate for Payer: Multiplan Commercial	$220.50

HC LAB REF FISH WILLIAMS SYNDROME

Facility

$20.00

Service Code	CPT 88291
Hospital Charge Code	900910695
Hospital Revenue Code	310
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$16.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Commercial	$15.00

HC LAB REF FISH WILLIAMS SYNDROME

Facility

$20.00

Service Code	CPT 88291
Hospital Charge Code	900910695
Hospital Revenue Code	310
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.00
Rate for Payer: Aetna of CA Government/Medicare	$12.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Commercial	$15.00

HC LAB REF FLUCONAZOLE LEVEL

Facility

$22.00

Service Code	CPT 80299
Hospital Charge Code	900912710
Hospital Revenue Code	301
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$18.64
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: Cash Price	$9.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$17.60
Rate for Payer: Health Smart Auto/Commercial	$13.20
Rate for Payer: Intervalley Health Plan Commercial	$18.64
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 Commercial	$16.50

HC LAB REF FLUCONAZOLE LEVEL

Facility

$22.00

Service Code	CPT 80299
Hospital Charge Code	900912710
Hospital Revenue Code	301
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$17.60
Rate for Payer: Cash Price	$9.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$17.60
Rate for Payer: Health Smart Auto/Commercial	$13.20
Rate for Payer: LLUH Dept of Risk Management WC	$12.10
Rate for Payer: Multiplan Commercial	$16.50

HC LAB REF GAMMA GLOBULIN SUBCLASS

Facility

$22.00

Service Code	CPT 82787
Hospital Charge Code	900912587
Hospital Revenue Code	301
Min. Negotiated Rate	$8.02
Max. Negotiated Rate	$17.60
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: Cash Price	$9.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$17.60
Rate for Payer: Health Smart Auto/Commercial	$13.20
Rate for Payer: Intervalley Health Plan Commercial	$8.02
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 Commercial	$16.50

HC LAB REF GAMMA GLOBULIN SUBCLASS

Facility

$22.00

Service Code	CPT 82787
Hospital Charge Code	900912587
Hospital Revenue Code	301
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$17.60
Rate for Payer: Cash Price	$9.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$17.60
Rate for Payer: Health Smart Auto/Commercial	$13.20
Rate for Payer: LLUH Dept of Risk Management WC	$12.10
Rate for Payer: Multiplan Commercial	$16.50

HC LAB REF GAUCHER'S DISEASE PCR

Facility

$480.00

Service Code	CPT 81251
Hospital Charge Code	900910681
Hospital Revenue Code	301
Min. Negotiated Rate	$264.00
Max. Negotiated Rate	$384.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$384.00
Rate for Payer: Health Smart Auto/Commercial	$288.00
Rate for Payer: LLUH Dept of Risk Management WC	$264.00
Rate for Payer: Multiplan Commercial	$360.00

HC LAB REF GAUCHER'S DISEASE PCR

Facility

$480.00

Service Code	CPT 81251
Hospital Charge Code	900910681
Hospital Revenue Code	301
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$384.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$288.00
Rate for Payer: Aetna of CA Government/Medicare	$288.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$384.00
Rate for Payer: Health Smart Auto/Commercial	$288.00
Rate for Payer: Intervalley Health Plan Commercial	$47.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$288.00
Rate for Payer: LLUH Dept of Risk Management WC	$264.00
Rate for Payer: Multiplan Commercial	$360.00

HC LAB REF GREEN COFFEE BEAN IGE

Facility

$13.00

Service Code	CPT 86003
Hospital Charge Code	900912523
Hospital Revenue Code	302
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$10.40
Rate for Payer: Cash Price	$5.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.40
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Commercial	$9.75

HC LAB REF GREEN COFFEE BEAN IGE

Facility

$13.00

Service Code	CPT 86003
Hospital Charge Code	900912523
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$10.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.80
Rate for Payer: Aetna of CA Government/Medicare	$7.80
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cash Price	$5.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.40
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: Intervalley Health Plan Commercial	$5.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Commercial	$9.75

HC LAB REF HEAVY METALS UR ARSENIC

Facility

$79.00

Service Code	CPT 82175
Hospital Charge Code	900912663
Hospital Revenue Code	301
Min. Negotiated Rate	$18.97
Max. Negotiated Rate	$63.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$47.40
Rate for Payer: Aetna of CA Government/Medicare	$47.40
Rate for Payer: Cash Price	$35.55
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: Intervalley Health Plan Commercial	$18.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$47.40
Rate for Payer: LLUH Dept of Risk Management WC	$43.45
Rate for Payer: Multiplan Commercial	$59.25

HC LAB REF HEAVY METALS UR ARSENIC

Facility

$79.00

Service Code	CPT 82175
Hospital Charge Code	900912663
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 HEAVY METALS UR CADMIUM

Facility

$96.00

Service Code	CPT 82300
Hospital Charge Code	900912662
Hospital Revenue Code	301
Min. Negotiated Rate	$23.64
Max. Negotiated Rate	$76.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$57.60
Rate for Payer: Aetna of CA Government/Medicare	$57.60
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$76.80
Rate for Payer: Health Smart Auto/Commercial	$57.60
Rate for Payer: Intervalley Health Plan Commercial	$23.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$57.60
Rate for Payer: LLUH Dept of Risk Management WC	$52.80
Rate for Payer: Multiplan Commercial	$72.00

Know your out-of-pocket cost for care.

All Charges