Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC LAB REF PENTOBARBITAL

Facility

$181.00

Service Code	CPT 80345
Hospital Charge Code	900911216
Hospital Revenue Code	301
Min. Negotiated Rate	$99.55
Max. Negotiated Rate	$144.80
Rate for Payer: Cash Price	$81.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$144.80
Rate for Payer: Health Smart Auto/Commercial	$108.60
Rate for Payer: LLUH Dept of Risk Management WC	$99.55
Rate for Payer: Multiplan Commercial	$135.75

HC LAB REF PENTOBARBITAL

Facility

$181.00

Service Code	CPT 80345
Hospital Charge Code	900911216
Hospital Revenue Code	301
Min. Negotiated Rate	$99.55
Max. Negotiated Rate	$144.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$108.60
Rate for Payer: Aetna of CA Government/Medicare	$108.60
Rate for Payer: Cash Price	$81.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$144.80
Rate for Payer: Health Smart Auto/Commercial	$108.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$108.60
Rate for Payer: LLUH Dept of Risk Management WC	$99.55
Rate for Payer: Multiplan Commercial	$135.75

HC LAB REF PHOSPHOTIDYLSERINE IGA

Facility

$49.00

Service Code	CPT 86148
Hospital Charge Code	900911381
Hospital Revenue Code	301
Min. Negotiated Rate	$26.95
Max. Negotiated Rate	$39.20
Rate for Payer: Cash Price	$22.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$39.20
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: LLUH Dept of Risk Management WC	$26.95
Rate for Payer: Multiplan Commercial	$36.75

HC LAB REF PHOSPHOTIDYLSERINE IGA

Facility

$49.00

Service Code	CPT 86148
Hospital Charge Code	900911381
Hospital Revenue Code	301
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$39.20
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: Cash Price	$22.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$39.20
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: Intervalley Health Plan Commercial	$16.07
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 Commercial	$36.75

HC LAB REF PHOSPHOTIDYLSERINE IGG

Facility

$49.00

Service Code	CPT 86148
Hospital Charge Code	900911382
Hospital Revenue Code	301
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$39.20
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: Cash Price	$22.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$39.20
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: Intervalley Health Plan Commercial	$16.07
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 Commercial	$36.75

HC LAB REF PHOSPHOTIDYLSERINE IGG

Facility

$49.00

Service Code	CPT 86148
Hospital Charge Code	900911382
Hospital Revenue Code	301
Min. Negotiated Rate	$26.95
Max. Negotiated Rate	$39.20
Rate for Payer: Cash Price	$22.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$39.20
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: LLUH Dept of Risk Management WC	$26.95
Rate for Payer: Multiplan Commercial	$36.75

HC LAB REF PHOSPHOTIDYLSERINE IGM

Facility

$49.00

Service Code	CPT 86148
Hospital Charge Code	900911383
Hospital Revenue Code	301
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$39.20
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: Cash Price	$22.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$39.20
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: Intervalley Health Plan Commercial	$16.07
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 Commercial	$36.75

HC LAB REF PHOSPHOTIDYLSERINE IGM

Facility

$49.00

Service Code	CPT 86148
Hospital Charge Code	900911383
Hospital Revenue Code	301
Min. Negotiated Rate	$26.95
Max. Negotiated Rate	$39.20
Rate for Payer: Cash Price	$22.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$39.20
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: LLUH Dept of Risk Management WC	$26.95
Rate for Payer: Multiplan Commercial	$36.75

HC LAB REF PROTEIN ELECT BODY FLUID

Facility

$28.00

Service Code	CPT 84166
Hospital Charge Code	900912678
Hospital Revenue Code	301
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$22.40
Rate for Payer: Cash Price	$12.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.40
Rate for Payer: Health Smart Auto/Commercial	$16.80
Rate for Payer: LLUH Dept of Risk Management WC	$15.40
Rate for Payer: Multiplan Commercial	$21.00

HC LAB REF PROTEIN ELECT BODY FLUID

Facility

$28.00

Service Code	CPT 84166
Hospital Charge Code	900912678
Hospital Revenue Code	301
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$22.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.80
Rate for Payer: Aetna of CA Government/Medicare	$16.80
Rate for Payer: Cash Price	$12.60
Rate for Payer: Cash Price	$12.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.40
Rate for Payer: Health Smart Auto/Commercial	$16.80
Rate for Payer: Intervalley Health Plan Commercial	$17.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.80
Rate for Payer: LLUH Dept of Risk Management WC	$15.40
Rate for Payer: Multiplan Commercial	$21.00

HC LAB REF PROTEIN TOTAL (SO)

Facility

$36.00

Service Code	CPT 84155
Hospital Charge Code	900912825
Hospital Revenue Code	301
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$28.80
Rate for Payer: Cash Price	$16.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$28.80
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Commercial	$27.00

HC LAB REF PROTEIN TOTAL (SO)

Facility

$36.00

Service Code	CPT 84155
Hospital Charge Code	900912825
Hospital Revenue Code	301
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.60
Rate for Payer: Aetna of CA Government/Medicare	$21.60
Rate for Payer: Cash Price	$16.20
Rate for Payer: Cash Price	$16.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$28.80
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: Intervalley Health Plan Commercial	$3.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Commercial	$27.00

HC LAB REF QUINIDINE

Facility

$67.00

Service Code	CPT 80194
Hospital Charge Code	900910456
Hospital Revenue Code	301
Min. Negotiated Rate	$14.60
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	$14.60
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 QUINIDINE

Facility

$67.00

Service Code	CPT 80194
Hospital Charge Code	900910456
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 RAJI CELL

Facility

$168.00

Service Code	CPT 86332
Hospital Charge Code	900911007
Hospital Revenue Code	302
Min. Negotiated Rate	$24.37
Max. Negotiated Rate	$134.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$100.80
Rate for Payer: Aetna of CA Government/Medicare	$100.80
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cash Price	$75.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$134.40
Rate for Payer: Health Smart Auto/Commercial	$100.80
Rate for Payer: Intervalley Health Plan Commercial	$24.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$100.80
Rate for Payer: LLUH Dept of Risk Management WC	$92.40
Rate for Payer: Multiplan Commercial	$126.00

HC LAB REF RAJI CELL

Facility

$168.00

Service Code	CPT 86332
Hospital Charge Code	900911007
Hospital Revenue Code	302
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$134.40
Rate for Payer: Cash Price	$75.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$134.40
Rate for Payer: Health Smart Auto/Commercial	$100.80
Rate for Payer: LLUH Dept of Risk Management WC	$92.40
Rate for Payer: Multiplan Commercial	$126.00

HC LAB REF RETICULIN AB

Facility

$14.00

Service Code	CPT 86255
Hospital Charge Code	900910788
Hospital Revenue Code	302
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$12.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.40
Rate for Payer: Aetna of CA Government/Medicare	$8.40
Rate for Payer: Cash Price	$6.30
Rate for Payer: Cash Price	$6.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$11.20
Rate for Payer: Health Smart Auto/Commercial	$8.40
Rate for Payer: Intervalley Health Plan Commercial	$12.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.40
Rate for Payer: LLUH Dept of Risk Management WC	$7.70
Rate for Payer: Multiplan Commercial	$10.50

HC LAB REF RETICULIN AB

Facility

$14.00

Service Code	CPT 86255
Hospital Charge Code	900910788
Hospital Revenue Code	302
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$11.20
Rate for Payer: Cash Price	$6.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$11.20
Rate for Payer: Health Smart Auto/Commercial	$8.40
Rate for Payer: LLUH Dept of Risk Management WC	$7.70
Rate for Payer: Multiplan Commercial	$10.50

HC LAB REF RIFAMPIN

Facility

$137.00

Service Code	CPT 80299
Hospital Charge Code	900911389
Hospital Revenue Code	301
Min. Negotiated Rate	$75.35
Max. Negotiated Rate	$109.60
Rate for Payer: Cash Price	$61.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$109.60
Rate for Payer: Health Smart Auto/Commercial	$82.20
Rate for Payer: LLUH Dept of Risk Management WC	$75.35
Rate for Payer: Multiplan Commercial	$102.75

HC LAB REF RIFAMPIN

Facility

$137.00

Service Code	CPT 80299
Hospital Charge Code	900911389
Hospital Revenue Code	301
Min. Negotiated Rate	$18.64
Max. Negotiated Rate	$109.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$82.20
Rate for Payer: Aetna of CA Government/Medicare	$82.20
Rate for Payer: Cash Price	$61.65
Rate for Payer: Cash Price	$61.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$109.60
Rate for Payer: Health Smart Auto/Commercial	$82.20
Rate for Payer: Intervalley Health Plan Commercial	$18.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$82.20
Rate for Payer: LLUH Dept of Risk Management WC	$75.35
Rate for Payer: Multiplan Commercial	$102.75

HC LAB REF ST LOUIS ENCEPH AB IGM

Facility

$21.00

Service Code	CPT 86653
Hospital Charge Code	900912652
Hospital Revenue Code	302
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$16.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.60
Rate for Payer: Aetna of CA Government/Medicare	$12.60
Rate for Payer: Cash Price	$9.45
Rate for Payer: Cash Price	$9.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.80
Rate for Payer: Health Smart Auto/Commercial	$12.60
Rate for Payer: Intervalley Health Plan Commercial	$13.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.60
Rate for Payer: LLUH Dept of Risk Management WC	$11.55
Rate for Payer: Multiplan Commercial	$15.75

HC LAB REF ST LOUIS ENCEPH AB IGM

Facility

$21.00

Service Code	CPT 86653
Hospital Charge Code	900912652
Hospital Revenue Code	302
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$16.80
Rate for Payer: Cash Price	$9.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.80
Rate for Payer: Health Smart Auto/Commercial	$12.60
Rate for Payer: LLUH Dept of Risk Management WC	$11.55
Rate for Payer: Multiplan Commercial	$15.75

HC LAB REF STRIATIONAL ABS

Facility

$21.00

Service Code	CPT 83520
Hospital Charge Code	900912585
Hospital Revenue Code	301
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$17.27
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.60
Rate for Payer: Aetna of CA Government/Medicare	$12.60
Rate for Payer: Cash Price	$9.45
Rate for Payer: Cash Price	$9.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.80
Rate for Payer: Health Smart Auto/Commercial	$12.60
Rate for Payer: Intervalley Health Plan Commercial	$17.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.60
Rate for Payer: LLUH Dept of Risk Management WC	$11.55
Rate for Payer: Multiplan Commercial	$15.75

HC LAB REF STRIATIONAL ABS

Facility

$21.00

Service Code	CPT 83520
Hospital Charge Code	900912585
Hospital Revenue Code	301
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$16.80
Rate for Payer: Cash Price	$9.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.80
Rate for Payer: Health Smart Auto/Commercial	$12.60
Rate for Payer: LLUH Dept of Risk Management WC	$11.55
Rate for Payer: Multiplan Commercial	$15.75

HC LAB REF SULFHEMOGLOBIN

Facility

$10.00

Service Code	CPT 83060
Hospital Charge Code	900910299
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.80
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	$8.80
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

Know your out-of-pocket cost for care.

All Charges