Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC LAB REF ACH RECEPTOR MODULATING ABS

Facility

$22.00

Service Code	CPT 83519
Hospital Charge Code	900912584
Hospital Revenue Code	301
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$17.60
Rate for Payer: Cash Price	$9.90
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$16.50

HC LAB REF ACH RECEPTOR MODULATING ABS

Facility

$22.00

Service Code	CPT 83519 90
Hospital Charge Code	900912584
Hospital Revenue Code	301
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$16.50
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: Health Smart Auto/Commercial	$13.20
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 Beech St/Commercial/PHCS	$16.50

HC LAB REF ACOMPARATIVE GENE HYBRIDIZATIO

Facility

$1,025.00

Service Code	CPT 81228
Hospital Charge Code	900912780
Hospital Revenue Code	309
Min. Negotiated Rate	$563.75
Max. Negotiated Rate	$768.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$615.00
Rate for Payer: Aetna of CA Government/Medicare	$615.00
Rate for Payer: Cash Price	$461.25
Rate for Payer: Health Smart Auto/Commercial	$615.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$615.00
Rate for Payer: LLUH Dept of Risk Management WC	$563.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$768.75

HC LAB REF ACOMPARATIVE GENE HYBRIDIZATIO

Facility

$1,025.00

Service Code	CPT 81228 90
Hospital Charge Code	900912780
Hospital Revenue Code	300
Min. Negotiated Rate	$563.75
Max. Negotiated Rate	$768.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$615.00
Rate for Payer: Aetna of CA Government/Medicare	$615.00
Rate for Payer: Cash Price	$461.25
Rate for Payer: Health Smart Auto/Commercial	$615.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$615.00
Rate for Payer: LLUH Dept of Risk Management WC	$563.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$768.75

HC LAB REF ACOMPARATIVE GENE HYBRIDIZATIO

Facility

$1,025.00

Service Code	CPT 81228 90
Hospital Charge Code	900912780
Hospital Revenue Code	300
Min. Negotiated Rate	$563.75
Max. Negotiated Rate	$820.00
Rate for Payer: Cash Price	$461.25
Rate for Payer: Cigna of CA HMO/PPO	$820.00
Rate for Payer: Health Smart Auto/Commercial	$615.00
Rate for Payer: LLUH Dept of Risk Management WC	$563.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$768.75

HC LAB REF ACOMPARATIVE GENE HYBRIDIZATIO

Facility

$1,025.00

Service Code	CPT 81228
Hospital Charge Code	900912780
Hospital Revenue Code	309
Min. Negotiated Rate	$563.75
Max. Negotiated Rate	$820.00
Rate for Payer: Cash Price	$461.25
Rate for Payer: Cigna of CA HMO/PPO	$820.00
Rate for Payer: Health Smart Auto/Commercial	$615.00
Rate for Payer: LLUH Dept of Risk Management WC	$563.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$768.75

HC LAB REF ADDITION KARYOTYPE

Facility

$40.00

Service Code	CPT 88280
Hospital Charge Code	900910745
Hospital Revenue Code	310
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$32.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cigna of CA HMO/PPO	$32.00
Rate for Payer: Health Smart Auto/Commercial	$24.00
Rate for Payer: LLUH Dept of Risk Management WC	$22.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.00

HC LAB REF ADDITION KARYOTYPE

Facility

$40.00

Service Code	CPT 88280 90
Hospital Charge Code	900910745
Hospital Revenue Code	310
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$32.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cigna of CA HMO/PPO	$32.00
Rate for Payer: Health Smart Auto/Commercial	$24.00
Rate for Payer: LLUH Dept of Risk Management WC	$22.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.00

HC LAB REF ADDITION KARYOTYPE

Facility

$40.00

Service Code	CPT 88280 90
Hospital Charge Code	900910745
Hospital Revenue Code	310
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.00
Rate for Payer: Aetna of CA Government/Medicare	$24.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Smart Auto/Commercial	$24.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.00
Rate for Payer: LLUH Dept of Risk Management WC	$22.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.00

HC LAB REF ADDITION KARYOTYPE

Facility

$40.00

Service Code	CPT 88280
Hospital Charge Code	900910745
Hospital Revenue Code	310
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.00
Rate for Payer: Aetna of CA Government/Medicare	$24.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Smart Auto/Commercial	$24.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.00
Rate for Payer: LLUH Dept of Risk Management WC	$22.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.00

HC LAB REF AEROBIC ROUTINE MIC PANEL

Facility

$14.00

Service Code	CPT 87186
Hospital Charge Code	900911299
Hospital Revenue Code	300
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$10.50
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: Health Smart Auto/Commercial	$8.40
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 Beech St/Commercial/PHCS	$10.50

HC LAB REF AEROBIC ROUTINE MIC PANEL

Facility

$14.00

Service Code	CPT 87186 90
Hospital Charge Code	900911299
Hospital Revenue Code	300
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$11.20
Rate for Payer: Cash Price	$6.30
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$10.50

HC LAB REF AEROBIC ROUTINE MIC PANEL

Facility

$14.00

Service Code	CPT 87186
Hospital Charge Code	900911299
Hospital Revenue Code	300
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$11.20
Rate for Payer: Cash Price	$6.30
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$10.50

HC LAB REF AEROBIC ROUTINE MIC PANEL

Facility

$14.00

Service Code	CPT 87186 90
Hospital Charge Code	900911299
Hospital Revenue Code	300
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$10.50
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: Health Smart Auto/Commercial	$8.40
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 Beech St/Commercial/PHCS	$10.50

HC LAB REF ALBUMIN CHARGE - SO

Facility

$8.00

Service Code	CPT 82040
Hospital Charge Code	900910549
Hospital Revenue Code	301
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$6.40
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$6.00

HC LAB REF ALBUMIN CHARGE - SO

Facility

$8.00

Service Code	CPT 82040 90
Hospital Charge Code	900910549
Hospital Revenue Code	301
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$6.00
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: Health Smart Auto/Commercial	$4.80
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 Beech St/Commercial/PHCS	$6.00

HC LAB REF ALBUMIN CHARGE - SO

Facility

$8.00

Service Code	CPT 82040
Hospital Charge Code	900910549
Hospital Revenue Code	301
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$6.00
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: Health Smart Auto/Commercial	$4.80
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 Beech St/Commercial/PHCS	$6.00

HC LAB REF ALBUMIN CHARGE - SO

Facility

$8.00

Service Code	CPT 82040 90
Hospital Charge Code	900910549
Hospital Revenue Code	301
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$6.40
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$6.00

HC LAB REF ALCOHOL METHYL

Facility

$79.00

Service Code	CPT G0480 90
Hospital Charge Code	900910716
Hospital Revenue Code	301
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$59.25
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: Health Smart Auto/Commercial	$47.40
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 Beech St/Commercial/PHCS	$59.25

HC LAB REF ALCOHOL METHYL

Facility

$79.00

Service Code	CPT 80320
Hospital Charge Code	900910716
Hospital Revenue Code	301
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$63.20
Rate for Payer: Cash Price	$35.55
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$59.25

HC LAB REF ALCOHOL METHYL

Facility

$79.00

Service Code	CPT 80320
Hospital Charge Code	900910716
Hospital Revenue Code	301
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$59.25
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: Health Smart Auto/Commercial	$47.40
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 Beech St/Commercial/PHCS	$59.25

HC LAB REF ALCOHOL METHYL

Facility

$79.00

Service Code	CPT G0480
Hospital Charge Code	900910716
Hospital Revenue Code	301
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$59.25
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: Health Smart Auto/Commercial	$47.40
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 Beech St/Commercial/PHCS	$59.25

HC LAB REF ALCOHOL METHYL

Facility

$79.00

Service Code	CPT G0480 90
Hospital Charge Code	900910716
Hospital Revenue Code	301
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$63.20
Rate for Payer: Cash Price	$35.55
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$59.25

HC LAB REF ALCOHOL METHYL

Facility

$79.00

Service Code	CPT G0480
Hospital Charge Code	900910716
Hospital Revenue Code	301
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$63.20
Rate for Payer: Cash Price	$35.55
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$59.25

HC LAB REF ALLERGEN INDIVIDUAL (RAST)

Facility

$8.00

Service Code	CPT 86003
Hospital Charge Code	900911010
Hospital Revenue Code	302
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$6.40
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$6.00

Know your out-of-pocket cost for care.

All Charges