Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC LAB REF LCM IGM

Facility

$44.00

Service Code	CPT 86727
Hospital Charge Code	900912723
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 LEUCINE AMINOPEPTIDASE

Facility

$78.00

Service Code	CPT 83670
Hospital Charge Code	900911220
Hospital Revenue Code	301
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

HC LAB REF LEUCINE AMINOPEPTIDASE

Facility

$78.00

Service Code	CPT 83670
Hospital Charge Code	900911220
Hospital Revenue Code	301
Min. Negotiated Rate	$9.81
Max. Negotiated Rate	$62.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$46.80
Rate for Payer: Aetna of CA Government/Medicare	$46.80
Rate for Payer: Cash Price	$35.10
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: Intervalley Health Plan Commercial	$9.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$46.80
Rate for Payer: LLUH Dept of Risk Management WC	$42.90
Rate for Payer: Multiplan Commercial	$58.50

HC LAB REF LIDOCAINE

Facility

$18.00

Service Code	CPT 80176
Hospital Charge Code	900910404
Hospital Revenue Code	301
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$14.69
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.80
Rate for Payer: Aetna of CA Government/Medicare	$10.80
Rate for Payer: Cash Price	$8.10
Rate for Payer: Cash Price	$8.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.40
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: Intervalley Health Plan Commercial	$14.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.80
Rate for Payer: LLUH Dept of Risk Management WC	$9.90
Rate for Payer: Multiplan Commercial	$13.50

HC LAB REF LIDOCAINE

Facility

$18.00

Service Code	CPT 80176
Hospital Charge Code	900910404
Hospital Revenue Code	301
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$14.40
Rate for Payer: Cash Price	$8.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.40
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: LLUH Dept of Risk Management WC	$9.90
Rate for Payer: Multiplan Commercial	$13.50

HC LAB REF LIPID PANEL, CARDIAC

Facility

$22.00

Service Code	CPT 80061
Hospital Charge Code	900912578
Hospital Revenue Code	301
Min. Negotiated Rate	$12.10
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	$13.39
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 LISTERIA AB

Facility

$110.00

Service Code	CPT 86609
Hospital Charge Code	900911391
Hospital Revenue Code	302
Min. Negotiated Rate	$60.50
Max. Negotiated Rate	$88.00
Rate for Payer: Cash Price	$49.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$88.00
Rate for Payer: Health Smart Auto/Commercial	$66.00
Rate for Payer: LLUH Dept of Risk Management WC	$60.50
Rate for Payer: Multiplan Commercial	$82.50

HC LAB REF LISTERIA AB

Facility

$110.00

Service Code	CPT 86609
Hospital Charge Code	900911391
Hospital Revenue Code	302
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$88.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$66.00
Rate for Payer: Aetna of CA Government/Medicare	$66.00
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$88.00
Rate for Payer: Health Smart Auto/Commercial	$66.00
Rate for Payer: Intervalley Health Plan Commercial	$12.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$66.00
Rate for Payer: LLUH Dept of Risk Management WC	$60.50
Rate for Payer: Multiplan Commercial	$82.50

HC LAB REF MERCURY URINE

Facility

$23.00

Service Code	CPT 83830
Hospital Charge Code	900911144
Hospital Revenue Code	301
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$18.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.80
Rate for Payer: Aetna of CA Government/Medicare	$13.80
Rate for Payer: Cash Price	$10.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$18.40
Rate for Payer: Health Smart Auto/Commercial	$13.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.80
Rate for Payer: LLUH Dept of Risk Management WC	$12.65
Rate for Payer: Multiplan Commercial	$17.25

HC LAB REF MERCURY URINE

Facility

$23.00

Service Code	CPT 83830
Hospital Charge Code	900911144
Hospital Revenue Code	301
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$18.40
Rate for Payer: Cash Price	$10.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$18.40
Rate for Payer: Health Smart Auto/Commercial	$13.80
Rate for Payer: LLUH Dept of Risk Management WC	$12.65
Rate for Payer: Multiplan Commercial	$17.25

HC LAB REF METHEMALBUMIN

Facility

$115.00

Service Code	CPT 83857
Hospital Charge Code	900911067
Hospital Revenue Code	301
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$92.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$69.00
Rate for Payer: Aetna of CA Government/Medicare	$69.00
Rate for Payer: Cash Price	$51.75
Rate for Payer: Cash Price	$51.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$92.00
Rate for Payer: Health Smart Auto/Commercial	$69.00
Rate for Payer: Intervalley Health Plan Commercial	$10.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$69.00
Rate for Payer: LLUH Dept of Risk Management WC	$63.25
Rate for Payer: Multiplan Commercial	$86.25

HC LAB REF METHEMALBUMIN

Facility

$115.00

Service Code	CPT 83857
Hospital Charge Code	900911067
Hospital Revenue Code	301
Min. Negotiated Rate	$63.25
Max. Negotiated Rate	$92.00
Rate for Payer: Cash Price	$51.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$92.00
Rate for Payer: Health Smart Auto/Commercial	$69.00
Rate for Payer: LLUH Dept of Risk Management WC	$63.25
Rate for Payer: Multiplan Commercial	$86.25

HC LAB REF METHEMOGLOBIN

Facility

$10.00

Service Code	CPT 83050
Hospital Charge Code	900910295
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.00
Rate for Payer: Aetna of CA Government/Medicare	$6.00
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cash Price	$4.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.00
Rate for Payer: Health Smart Auto/Commercial	$6.00
Rate for Payer: Intervalley Health Plan Commercial	$8.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.00
Rate for Payer: LLUH Dept of Risk Management WC	$5.50
Rate for Payer: Multiplan Commercial	$7.50

HC LAB REF METHEMOGLOBIN

Facility

$10.00

Service Code	CPT 83050
Hospital Charge Code	900910295
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.00
Rate for Payer: Cash Price	$4.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.00
Rate for Payer: Health Smart Auto/Commercial	$6.00
Rate for Payer: LLUH Dept of Risk Management WC	$5.50
Rate for Payer: Multiplan Commercial	$7.50

HC LAB REF MITOCHONDRIAL DNA

Facility

$1,316.00

Service Code	CPT 84999
Hospital Charge Code	900911407
Hospital Revenue Code	302
Min. Negotiated Rate	$723.80
Max. Negotiated Rate	$1,052.80
Rate for Payer: Cash Price	$592.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,052.80
Rate for Payer: Health Smart Auto/Commercial	$789.60
Rate for Payer: LLUH Dept of Risk Management WC	$723.80
Rate for Payer: Multiplan Commercial	$987.00

HC LAB REF MITOCHONDRIAL DNA

Facility

$1,316.00

Service Code	CPT 84999
Hospital Charge Code	900911407
Hospital Revenue Code	302
Min. Negotiated Rate	$723.80
Max. Negotiated Rate	$1,052.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$789.60
Rate for Payer: Aetna of CA Government/Medicare	$789.60
Rate for Payer: Cash Price	$592.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,052.80
Rate for Payer: Health Smart Auto/Commercial	$789.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$789.60
Rate for Payer: LLUH Dept of Risk Management WC	$723.80
Rate for Payer: Multiplan Commercial	$987.00

HC LAB REF MMR MUMPS IGG IFA

Facility

$54.00

Service Code	CPT 86735
Hospital Charge Code	900912870
Hospital Revenue Code	302
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$32.40
Rate for Payer: Aetna of CA Government/Medicare	$32.40
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cash Price	$24.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$43.20
Rate for Payer: Health Smart Auto/Commercial	$32.40
Rate for Payer: Intervalley Health Plan Commercial	$13.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$32.40
Rate for Payer: LLUH Dept of Risk Management WC	$29.70
Rate for Payer: Multiplan Commercial	$40.50

HC LAB REF MMR MUMPS IGG IFA

Facility

$54.00

Service Code	CPT 86735
Hospital Charge Code	900912870
Hospital Revenue Code	302
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$43.20
Rate for Payer: Cash Price	$24.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$43.20
Rate for Payer: Health Smart Auto/Commercial	$32.40
Rate for Payer: LLUH Dept of Risk Management WC	$29.70
Rate for Payer: Multiplan Commercial	$40.50

HC LAB REF MMR RUBELLA IGG ELISA

Facility

$60.00

Service Code	CPT 86762
Hospital Charge Code	900912871
Hospital Revenue Code	302
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$48.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$36.00
Rate for Payer: Aetna of CA Government/Medicare	$36.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$48.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: Intervalley Health Plan Commercial	$14.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Commercial	$45.00

HC LAB REF MMR RUBELLA IGG ELISA

Facility

$60.00

Service Code	CPT 86762
Hospital Charge Code	900912871
Hospital Revenue Code	302
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$48.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$48.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Commercial	$45.00

HC LAB REF MMR RUBEOLA IGG IFA

Facility

$53.00

Service Code	CPT 86765
Hospital Charge Code	900912869
Hospital Revenue Code	302
Min. Negotiated Rate	$29.15
Max. Negotiated Rate	$42.40
Rate for Payer: Cash Price	$23.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$42.40
Rate for Payer: Health Smart Auto/Commercial	$31.80
Rate for Payer: LLUH Dept of Risk Management WC	$29.15
Rate for Payer: Multiplan Commercial	$39.75

HC LAB REF MMR RUBEOLA IGG IFA

Facility

$53.00

Service Code	CPT 86765
Hospital Charge Code	900912869
Hospital Revenue Code	302
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$42.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$31.80
Rate for Payer: Aetna of CA Government/Medicare	$31.80
Rate for Payer: Cash Price	$23.85
Rate for Payer: Cash Price	$23.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$42.40
Rate for Payer: Health Smart Auto/Commercial	$31.80
Rate for Payer: Intervalley Health Plan Commercial	$12.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$31.80
Rate for Payer: LLUH Dept of Risk Management WC	$29.15
Rate for Payer: Multiplan Commercial	$39.75

HC LAB REF MOLECULAR CYTOGENETICS,DNA PRO

Facility

$34.00

Service Code	CPT 88271
Hospital Charge Code	900910683
Hospital Revenue Code	310
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$27.20
Rate for Payer: Cash Price	$15.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$27.20
Rate for Payer: Health Smart Auto/Commercial	$20.40
Rate for Payer: LLUH Dept of Risk Management WC	$18.70
Rate for Payer: Multiplan Commercial	$25.50

HC LAB REF MOLECULAR CYTOGENETICS,DNA PRO

Facility

$34.00

Service Code	CPT 88271
Hospital Charge Code	900910683
Hospital Revenue Code	310
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$27.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.40
Rate for Payer: Aetna of CA Government/Medicare	$20.40
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cash Price	$15.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$27.20
Rate for Payer: Health Smart Auto/Commercial	$20.40
Rate for Payer: Intervalley Health Plan Commercial	$21.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.40
Rate for Payer: LLUH Dept of Risk Management WC	$18.70
Rate for Payer: Multiplan Commercial	$25.50

HC LAB REF MOLECULAR CYTOGENTCS 100-300CE

Facility

$64.00

Service Code	CPT 88275
Hospital Charge Code	900910679
Hospital Revenue Code	310
Min. Negotiated Rate	$35.20
Max. Negotiated Rate	$51.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$38.40
Rate for Payer: Aetna of CA Government/Medicare	$38.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$51.20
Rate for Payer: Health Smart Auto/Commercial	$38.40
Rate for Payer: Intervalley Health Plan Commercial	$51.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$38.40
Rate for Payer: LLUH Dept of Risk Management WC	$35.20
Rate for Payer: Multiplan Commercial	$48.00

Know your out-of-pocket cost for care.

All Charges