Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC LAB REF IGF-BP2

Facility

$67.00

Service Code	CPT 83519
Hospital Charge Code	900911427
Hospital Revenue Code	301
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$53.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$40.20
Rate for Payer: Aetna of CA Government/Medicare	$40.20
Rate for Payer: Cash Price	$30.15
Rate for Payer: Cash Price	$30.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$53.60
Rate for Payer: Health Smart Auto/Commercial	$40.20
Rate for Payer: Intervalley Health Plan Commercial	$18.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$40.20
Rate for Payer: LLUH Dept of Risk Management WC	$36.85
Rate for Payer: Multiplan Commercial	$50.25

HC LAB REF IGF-BP2

Facility

$67.00

Service Code	CPT 83519
Hospital Charge Code	900911427
Hospital Revenue Code	301
Min. Negotiated Rate	$36.85
Max. Negotiated Rate	$53.60
Rate for Payer: Cash Price	$30.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$53.60
Rate for Payer: Health Smart Auto/Commercial	$40.20
Rate for Payer: LLUH Dept of Risk Management WC	$36.85
Rate for Payer: Multiplan Commercial	$50.25

HC LAB REF IMMUNE COMPLEX PANEL C1Q

Facility

$81.00

Service Code	CPT 86332
Hospital Charge Code	900912836
Hospital Revenue Code	302
Min. Negotiated Rate	$44.55
Max. Negotiated Rate	$64.80
Rate for Payer: Cash Price	$36.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$64.80
Rate for Payer: Health Smart Auto/Commercial	$48.60
Rate for Payer: LLUH Dept of Risk Management WC	$44.55
Rate for Payer: Multiplan Commercial	$60.75

HC LAB REF IMMUNE COMPLEX PANEL C1Q

Facility

$81.00

Service Code	CPT 86332
Hospital Charge Code	900912836
Hospital Revenue Code	302
Min. Negotiated Rate	$24.37
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$48.60
Rate for Payer: Aetna of CA Government/Medicare	$48.60
Rate for Payer: Cash Price	$36.45
Rate for Payer: Cash Price	$36.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$64.80
Rate for Payer: Health Smart Auto/Commercial	$48.60
Rate for Payer: Intervalley Health Plan Commercial	$24.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$48.60
Rate for Payer: LLUH Dept of Risk Management WC	$44.55
Rate for Payer: Multiplan Commercial	$60.75

HC LAB REF IMMUNE COMPLEX PANEL C3D

Facility

$81.00

Service Code	CPT 86332
Hospital Charge Code	900912837
Hospital Revenue Code	302
Min. Negotiated Rate	$24.37
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$48.60
Rate for Payer: Aetna of CA Government/Medicare	$48.60
Rate for Payer: Cash Price	$36.45
Rate for Payer: Cash Price	$36.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$64.80
Rate for Payer: Health Smart Auto/Commercial	$48.60
Rate for Payer: Intervalley Health Plan Commercial	$24.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$48.60
Rate for Payer: LLUH Dept of Risk Management WC	$44.55
Rate for Payer: Multiplan Commercial	$60.75

HC LAB REF IMMUNE COMPLEX PANEL C3D

Facility

$81.00

Service Code	CPT 86332
Hospital Charge Code	900912837
Hospital Revenue Code	302
Min. Negotiated Rate	$44.55
Max. Negotiated Rate	$64.80
Rate for Payer: Cash Price	$36.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$64.80
Rate for Payer: Health Smart Auto/Commercial	$48.60
Rate for Payer: LLUH Dept of Risk Management WC	$44.55
Rate for Payer: Multiplan Commercial	$60.75

HC LAB REF IMMUNE COMPLEX PANEL PEG

Facility

$81.00

Service Code	CPT 86332
Hospital Charge Code	900911375
Hospital Revenue Code	302
Min. Negotiated Rate	$24.37
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$48.60
Rate for Payer: Aetna of CA Government/Medicare	$48.60
Rate for Payer: Cash Price	$36.45
Rate for Payer: Cash Price	$36.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$64.80
Rate for Payer: Health Smart Auto/Commercial	$48.60
Rate for Payer: Intervalley Health Plan Commercial	$24.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$48.60
Rate for Payer: LLUH Dept of Risk Management WC	$44.55
Rate for Payer: Multiplan Commercial	$60.75

HC LAB REF IMMUNE COMPLEX PANEL PEG

Facility

$81.00

Service Code	CPT 86332
Hospital Charge Code	900911375
Hospital Revenue Code	302
Min. Negotiated Rate	$44.55
Max. Negotiated Rate	$64.80
Rate for Payer: Cash Price	$36.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$64.80
Rate for Payer: Health Smart Auto/Commercial	$48.60
Rate for Payer: LLUH Dept of Risk Management WC	$44.55
Rate for Payer: Multiplan Commercial	$60.75

HC LAB REF IMMUNO FIXATION ELECTROPHORESI

Facility

$179.00

Service Code	CPT 86334
Hospital Charge Code	900912722
Hospital Revenue Code	301
Min. Negotiated Rate	$22.34
Max. Negotiated Rate	$143.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$107.40
Rate for Payer: Aetna of CA Government/Medicare	$107.40
Rate for Payer: Cash Price	$80.55
Rate for Payer: Cash Price	$80.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$143.20
Rate for Payer: Health Smart Auto/Commercial	$107.40
Rate for Payer: Intervalley Health Plan Commercial	$22.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$107.40
Rate for Payer: LLUH Dept of Risk Management WC	$98.45
Rate for Payer: Multiplan Commercial	$134.25

HC LAB REF IMMUNO FIXATION ELECTROPHORESI

Facility

$179.00

Service Code	CPT 86334
Hospital Charge Code	900912722
Hospital Revenue Code	301
Min. Negotiated Rate	$98.45
Max. Negotiated Rate	$143.20
Rate for Payer: Cash Price	$80.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$143.20
Rate for Payer: Health Smart Auto/Commercial	$107.40
Rate for Payer: LLUH Dept of Risk Management WC	$98.45
Rate for Payer: Multiplan Commercial	$134.25

HC LAB REF IMMUNO FIXATION ELECTRO UR

Facility

$47.00

Service Code	CPT 86335
Hospital Charge Code	900912719
Hospital Revenue Code	301
Min. Negotiated Rate	$25.85
Max. Negotiated Rate	$37.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$28.20
Rate for Payer: Aetna of CA Government/Medicare	$28.20
Rate for Payer: Cash Price	$21.15
Rate for Payer: Cash Price	$21.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$37.60
Rate for Payer: Health Smart Auto/Commercial	$28.20
Rate for Payer: Intervalley Health Plan Commercial	$29.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$28.20
Rate for Payer: LLUH Dept of Risk Management WC	$25.85
Rate for Payer: Multiplan Commercial	$35.25

HC LAB REF IMMUNO FIXATION ELECTRO UR

Facility

$47.00

Service Code	CPT 86335
Hospital Charge Code	900912719
Hospital Revenue Code	301
Min. Negotiated Rate	$25.85
Max. Negotiated Rate	$37.60
Rate for Payer: Cash Price	$21.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$37.60
Rate for Payer: Health Smart Auto/Commercial	$28.20
Rate for Payer: LLUH Dept of Risk Management WC	$25.85
Rate for Payer: Multiplan Commercial	$35.25

HC LAB REF IMMUNOGLOBULINS IGA SALIVARY

Facility

$111.00

Service Code	CPT 82784
Hospital Charge Code	900911376
Hospital Revenue Code	301
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$88.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$66.60
Rate for Payer: Aetna of CA Government/Medicare	$66.60
Rate for Payer: Cash Price	$49.95
Rate for Payer: Cash Price	$49.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$88.80
Rate for Payer: Health Smart Auto/Commercial	$66.60
Rate for Payer: Intervalley Health Plan Commercial	$9.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$66.60
Rate for Payer: LLUH Dept of Risk Management WC	$61.05
Rate for Payer: Multiplan Commercial	$83.25

HC LAB REF IMMUNOGLOBULINS IGA SALIVARY

Facility

$111.00

Service Code	CPT 82784
Hospital Charge Code	900911376
Hospital Revenue Code	301
Min. Negotiated Rate	$61.05
Max. Negotiated Rate	$88.80
Rate for Payer: Cash Price	$49.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$88.80
Rate for Payer: Health Smart Auto/Commercial	$66.60
Rate for Payer: LLUH Dept of Risk Management WC	$61.05
Rate for Payer: Multiplan Commercial	$83.25

HC LAB REF INFLUENZA A AB IGM

Facility

$17.00

Service Code	CPT 86710
Hospital Charge Code	900912806
Hospital Revenue Code	302
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$13.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.20
Rate for Payer: Aetna of CA Government/Medicare	$10.20
Rate for Payer: Cash Price	$7.65
Rate for Payer: Cash Price	$7.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.60
Rate for Payer: Health Smart Auto/Commercial	$10.20
Rate for Payer: Intervalley Health Plan Commercial	$13.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.20
Rate for Payer: LLUH Dept of Risk Management WC	$9.35
Rate for Payer: Multiplan Commercial	$12.75

HC LAB REF INFLUENZA A AB IGM

Facility

$17.00

Service Code	CPT 86710
Hospital Charge Code	900912806
Hospital Revenue Code	302
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$13.60
Rate for Payer: Cash Price	$7.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.60
Rate for Payer: Health Smart Auto/Commercial	$10.20
Rate for Payer: LLUH Dept of Risk Management WC	$9.35
Rate for Payer: Multiplan Commercial	$12.75

HC LAB REF INFLUENZA B AB IGM

Facility

$8.00

Service Code	CPT 86710
Hospital Charge Code	900912807
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 INFLUENZA B AB IGM

Facility

$8.00

Service Code	CPT 86710
Hospital Charge Code	900912807
Hospital Revenue Code	302
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$13.55
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	$13.55
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 INTERPHASE IN SITU HYBRIDIZATI

Facility

$56.00

Service Code	CPT 88275
Hospital Charge Code	900912582
Hospital Revenue Code	310
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 INTERPHASE IN SITU HYBRIDIZATI

Facility

$56.00

Service Code	CPT 88275
Hospital Charge Code	900912582
Hospital Revenue Code	310
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$51.19
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	$51.19
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 KIDNEY BEAN (RED) IGE

Facility

$13.00

Service Code	CPT 86003
Hospital Charge Code	900912529
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 KIDNEY BEAN (RED) IGE

Facility

$13.00

Service Code	CPT 86003
Hospital Charge Code	900912529
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 LCM IGG

Facility

$44.00

Service Code	CPT 86727
Hospital Charge Code	900911470
Hospital Revenue Code	302
Min. Negotiated Rate	$12.87
Max. Negotiated Rate	$35.20
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: Cash Price	$19.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$35.20
Rate for Payer: Health Smart Auto/Commercial	$26.40
Rate for Payer: Intervalley Health Plan Commercial	$12.87
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 Commercial	$33.00

HC LAB REF LCM IGG

Facility

$44.00

Service Code	CPT 86727
Hospital Charge Code	900911470
Hospital Revenue Code	302
Min. Negotiated Rate	$24.20
Max. Negotiated Rate	$35.20
Rate for Payer: Cash Price	$19.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$35.20
Rate for Payer: Health Smart Auto/Commercial	$26.40
Rate for Payer: LLUH Dept of Risk Management WC	$24.20
Rate for Payer: Multiplan Commercial	$33.00

HC LAB REF LCM IGM

Facility

$44.00

Service Code	CPT 86727
Hospital Charge Code	900912723
Hospital Revenue Code	302
Min. Negotiated Rate	$12.87
Max. Negotiated Rate	$35.20
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: Cash Price	$19.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$35.20
Rate for Payer: Health Smart Auto/Commercial	$26.40
Rate for Payer: Intervalley Health Plan Commercial	$12.87
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 Commercial	$33.00

Know your out-of-pocket cost for care.

All Charges