Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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	$8.00
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 T3 UPTAKE

Facility

$10.00

Service Code	CPT 84479
Hospital Charge Code	900910792
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.00
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	$6.47
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 T3 UPTAKE

Facility

$10.00

Service Code	CPT 84479
Hospital Charge Code	900910792
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 TISSUE CULT OTHER SOLID TISSUE

Facility

$75.00

Service Code	CPT 88291
Hospital Charge Code	900910776
Hospital Revenue Code	310
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$45.00
Rate for Payer: Aetna of CA Government/Medicare	$45.00
Rate for Payer: Cash Price	$33.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$60.00
Rate for Payer: Health Smart Auto/Commercial	$45.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$45.00
Rate for Payer: LLUH Dept of Risk Management WC	$41.25
Rate for Payer: Multiplan Commercial	$56.25

HC LAB REF TISSUE CULT OTHER SOLID TISSUE

Facility

$75.00

Service Code	CPT 88291
Hospital Charge Code	900910776
Hospital Revenue Code	310
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$60.00
Rate for Payer: Cash Price	$33.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$60.00
Rate for Payer: Health Smart Auto/Commercial	$45.00
Rate for Payer: LLUH Dept of Risk Management WC	$41.25
Rate for Payer: Multiplan Commercial	$56.25

HC LAB REF TISSUE CULTURE LYMPHOCYTE NON

Facility

$101.00

Service Code	CPT 88230
Hospital Charge Code	900910686
Hospital Revenue Code	310
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 TISSUE CULTURE LYMPHOCYTE NON

Facility

$101.00

Service Code	CPT 88230
Hospital Charge Code	900910686
Hospital Revenue Code	310
Min. Negotiated Rate	$55.55
Max. Negotiated Rate	$116.49
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	$116.49
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 TISSUE CULTURE NEO BLOOD/BONE

Facility

$203.00

Service Code	CPT 88237
Hospital Charge Code	900912791
Hospital Revenue Code	310
Min. Negotiated Rate	$111.65
Max. Negotiated Rate	$162.40
Rate for Payer: Cash Price	$91.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$162.40
Rate for Payer: Health Smart Auto/Commercial	$121.80
Rate for Payer: LLUH Dept of Risk Management WC	$111.65
Rate for Payer: Multiplan Commercial	$152.25

HC LAB REF TISSUE CULTURE NEO BLOOD/BONE

Facility

$203.00

Service Code	CPT 88237
Hospital Charge Code	900912791
Hospital Revenue Code	310
Min. Negotiated Rate	$111.65
Max. Negotiated Rate	$162.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$121.80
Rate for Payer: Aetna of CA Government/Medicare	$121.80
Rate for Payer: Cash Price	$91.35
Rate for Payer: Cash Price	$91.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$162.40
Rate for Payer: Health Smart Auto/Commercial	$121.80
Rate for Payer: Intervalley Health Plan Commercial	$143.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$121.80
Rate for Payer: LLUH Dept of Risk Management WC	$111.65
Rate for Payer: Multiplan Commercial	$152.25

HC LAB REF TISSUE CULTURE NEO SOLID TUMOR

Facility

$237.00

Service Code	CPT 88239
Hospital Charge Code	900912792
Hospital Revenue Code	310
Min. Negotiated Rate	$130.35
Max. Negotiated Rate	$189.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$142.20
Rate for Payer: Aetna of CA Government/Medicare	$142.20
Rate for Payer: Cash Price	$106.65
Rate for Payer: Cash Price	$106.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$189.60
Rate for Payer: Health Smart Auto/Commercial	$142.20
Rate for Payer: Intervalley Health Plan Commercial	$147.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$142.20
Rate for Payer: LLUH Dept of Risk Management WC	$130.35
Rate for Payer: Multiplan Commercial	$177.75

HC LAB REF TISSUE CULTURE NEO SOLID TUMOR

Facility

$237.00

Service Code	CPT 88239
Hospital Charge Code	900912792
Hospital Revenue Code	310
Min. Negotiated Rate	$130.35
Max. Negotiated Rate	$189.60
Rate for Payer: Cash Price	$106.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$189.60
Rate for Payer: Health Smart Auto/Commercial	$142.20
Rate for Payer: LLUH Dept of Risk Management WC	$130.35
Rate for Payer: Multiplan Commercial	$177.75

HC LAB REF TISSUE CULTURE SKIN/SOLID TISS

Facility

$151.00

Service Code	CPT 88233
Hospital Charge Code	900912790
Hospital Revenue Code	310
Min. Negotiated Rate	$83.05
Max. Negotiated Rate	$140.73
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$90.60
Rate for Payer: Aetna of CA Government/Medicare	$90.60
Rate for Payer: Cash Price	$67.95
Rate for Payer: Cash Price	$67.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$120.80
Rate for Payer: Health Smart Auto/Commercial	$90.60
Rate for Payer: Intervalley Health Plan Commercial	$140.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$90.60
Rate for Payer: LLUH Dept of Risk Management WC	$83.05
Rate for Payer: Multiplan Commercial	$113.25

HC LAB REF TISSUE CULTURE SKIN/SOLID TISS

Facility

$151.00

Service Code	CPT 88233
Hospital Charge Code	900912790
Hospital Revenue Code	310
Min. Negotiated Rate	$83.05
Max. Negotiated Rate	$120.80
Rate for Payer: Cash Price	$67.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$120.80
Rate for Payer: Health Smart Auto/Commercial	$90.60
Rate for Payer: LLUH Dept of Risk Management WC	$83.05
Rate for Payer: Multiplan Commercial	$113.25

HC LAB REF TISSUE INSITU INTERP & REPORT

Facility

$54.00

Service Code	CPT 88365
Hospital Charge Code	900910703
Hospital Revenue Code	310
Min. Negotiated Rate	$29.70
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: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$43.20
Rate for Payer: Health Smart Auto/Commercial	$32.40
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 TISSUE INSITU INTERP & REPORT

Facility

$54.00

Service Code	CPT 88365
Hospital Charge Code	900910703
Hospital Revenue Code	310
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 TRYPSINOGEN

Facility

$70.00

Service Code	CPT 83519
Hospital Charge Code	900910733
Hospital Revenue Code	301
Min. Negotiated Rate	$18.40
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	$18.40
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 TRYPSINOGEN

Facility

$70.00

Service Code	CPT 83519
Hospital Charge Code	900910733
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 VARICELLA-ZOSTER AB ACIF CSF

Facility

$43.00

Service Code	CPT 87798
Hospital Charge Code	900911362
Hospital Revenue Code	302
Min. Negotiated Rate	$23.65
Max. Negotiated Rate	$35.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$25.80
Rate for Payer: Aetna of CA Government/Medicare	$25.80
Rate for Payer: Cash Price	$19.35
Rate for Payer: Cash Price	$19.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$34.40
Rate for Payer: Health Smart Auto/Commercial	$25.80
Rate for Payer: Intervalley Health Plan Commercial	$35.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$25.80
Rate for Payer: LLUH Dept of Risk Management WC	$23.65
Rate for Payer: Multiplan Commercial	$32.25

HC LAB REF VARICELLA-ZOSTER AB ACIF CSF

Facility

$43.00

Service Code	CPT 87798
Hospital Charge Code	900911362
Hospital Revenue Code	302
Min. Negotiated Rate	$23.65
Max. Negotiated Rate	$34.40
Rate for Payer: Cash Price	$19.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$34.40
Rate for Payer: Health Smart Auto/Commercial	$25.80
Rate for Payer: LLUH Dept of Risk Management WC	$23.65
Rate for Payer: Multiplan Commercial	$32.25

HC LAB REF VITAMIN D 1 25-DIHYDROXY

Facility

$24.00

Service Code	CPT 82652
Hospital Charge Code	900911098
Hospital Revenue Code	301
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$19.20
Rate for Payer: Cash Price	$10.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.20
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Commercial	$18.00

HC LAB REF VITAMIN D 1 25-DIHYDROXY

Facility

$24.00

Service Code	CPT 82652
Hospital Charge Code	900911098
Hospital Revenue Code	301
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$38.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.40
Rate for Payer: Aetna of CA Government/Medicare	$14.40
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$10.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.20
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: Intervalley Health Plan Commercial	$38.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Commercial	$18.00

HC LAB REF VZV AB IMMUNITY SCREEN

Facility

$87.00

Service Code	CPT 86787
Hospital Charge Code	900912872
Hospital Revenue Code	302
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$69.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$52.20
Rate for Payer: Aetna of CA Government/Medicare	$52.20
Rate for Payer: Cash Price	$39.15
Rate for Payer: Cash Price	$39.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$69.60
Rate for Payer: Health Smart Auto/Commercial	$52.20
Rate for Payer: Intervalley Health Plan Commercial	$12.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$52.20
Rate for Payer: LLUH Dept of Risk Management WC	$47.85
Rate for Payer: Multiplan Commercial	$65.25

HC LAB REF VZV AB IMMUNITY SCREEN

Facility

$87.00

Service Code	CPT 86787
Hospital Charge Code	900912872
Hospital Revenue Code	302
Min. Negotiated Rate	$47.85
Max. Negotiated Rate	$69.60
Rate for Payer: Cash Price	$39.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$69.60
Rate for Payer: Health Smart Auto/Commercial	$52.20
Rate for Payer: LLUH Dept of Risk Management WC	$47.85
Rate for Payer: Multiplan Commercial	$65.25

HC LAB REF WHITE BEAN IGE

Facility

$13.00

Service Code	CPT 86003
Hospital Charge Code	900912545
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 WHITE BEAN IGE

Facility

$13.00

Service Code	CPT 86003
Hospital Charge Code	900912545
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

Know your out-of-pocket cost for care.

All Charges