Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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	$6.00
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 ALLERGEN INDIVIDUAL (RAST)

Facility

$8.00

Service Code	CPT 86003 90
Hospital Charge Code	900911010
Hospital Revenue Code	302
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 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

HC LAB REF AMPHOTERICIN B

Facility

$101.00

Service Code	CPT 84999 90
Hospital Charge Code	900911105
Hospital Revenue Code	301
Min. Negotiated Rate	$55.55
Max. Negotiated Rate	$75.75
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: Health Smart Auto/Commercial	$60.60
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 Beech St/Commercial/PHCS	$75.75

HC LAB REF AMPHOTERICIN B

Facility

$101.00

Service Code	CPT 84999
Hospital Charge Code	900911105
Hospital Revenue Code	301
Min. Negotiated Rate	$55.55
Max. Negotiated Rate	$75.75
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: Health Smart Auto/Commercial	$60.60
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 Beech St/Commercial/PHCS	$75.75

HC LAB REF AMPHOTERICIN B

Facility

$101.00

Service Code	CPT 84999 90
Hospital Charge Code	900911105
Hospital Revenue Code	301
Min. Negotiated Rate	$55.55
Max. Negotiated Rate	$80.80
Rate for Payer: Cash Price	$45.45
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$75.75

HC LAB REF AMPHOTERICIN B

Facility

$101.00

Service Code	CPT 84999
Hospital Charge Code	900911105
Hospital Revenue Code	301
Min. Negotiated Rate	$55.55
Max. Negotiated Rate	$80.80
Rate for Payer: Cash Price	$45.45
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$75.75

HC LAB REF AMPICILIIN

Facility

$25.00

Service Code	CPT 80299
Hospital Charge Code	900911154
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$18.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.00
Rate for Payer: Aetna of CA Government/Medicare	$15.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.75

HC LAB REF AMPICILIIN

Facility

$25.00

Service Code	CPT 80299
Hospital Charge Code	900911154
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$20.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Cigna of CA HMO/PPO	$20.00
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.75

HC LAB REF AMPICILIIN

Facility

$25.00

Service Code	CPT 80299 90
Hospital Charge Code	900911154
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$20.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Cigna of CA HMO/PPO	$20.00
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.75

HC LAB REF AMPICILIIN

Facility

$25.00

Service Code	CPT 80299 90
Hospital Charge Code	900911154
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$18.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.00
Rate for Payer: Aetna of CA Government/Medicare	$15.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.75

HC LAB REF ANTI-EPITHELIAL AB

Facility

$19.00

Service Code	CPT 86256
Hospital Charge Code	900911410
Hospital Revenue Code	302
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$14.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.40
Rate for Payer: Aetna of CA Government/Medicare	$11.40
Rate for Payer: Cash Price	$8.55
Rate for Payer: Health Smart Auto/Commercial	$11.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.40
Rate for Payer: LLUH Dept of Risk Management WC	$10.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.25

HC LAB REF ANTI-EPITHELIAL AB

Facility

$19.00

Service Code	CPT 86256
Hospital Charge Code	900911410
Hospital Revenue Code	302
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$15.20
Rate for Payer: Cash Price	$8.55
Rate for Payer: Cigna of CA HMO/PPO	$15.20
Rate for Payer: Health Smart Auto/Commercial	$11.40
Rate for Payer: LLUH Dept of Risk Management WC	$10.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.25

HC LAB REF ANTI-EPITHELIAL AB

Facility

$19.00

Service Code	CPT 86256 90
Hospital Charge Code	900911410
Hospital Revenue Code	302
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$14.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.40
Rate for Payer: Aetna of CA Government/Medicare	$11.40
Rate for Payer: Cash Price	$8.55
Rate for Payer: Health Smart Auto/Commercial	$11.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.40
Rate for Payer: LLUH Dept of Risk Management WC	$10.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.25

HC LAB REF ANTI-EPITHELIAL AB

Facility

$19.00

Service Code	CPT 86256 90
Hospital Charge Code	900911410
Hospital Revenue Code	302
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$15.20
Rate for Payer: Cash Price	$8.55
Rate for Payer: Cigna of CA HMO/PPO	$15.20
Rate for Payer: Health Smart Auto/Commercial	$11.40
Rate for Payer: LLUH Dept of Risk Management WC	$10.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.25

HC LAB REF ANTI-PM1 AB

Facility

$101.00

Service Code	CPT 86235
Hospital Charge Code	900911424
Hospital Revenue Code	302
Min. Negotiated Rate	$55.55
Max. Negotiated Rate	$80.80
Rate for Payer: Cash Price	$45.45
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$75.75

HC LAB REF ANTI-PM1 AB

Facility

$101.00

Service Code	CPT 86235
Hospital Charge Code	900911424
Hospital Revenue Code	302
Min. Negotiated Rate	$55.55
Max. Negotiated Rate	$75.75
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: Health Smart Auto/Commercial	$60.60
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 Beech St/Commercial/PHCS	$75.75

HC LAB REF ANTI-PM1 AB

Facility

$101.00

Service Code	CPT 86235 90
Hospital Charge Code	900911424
Hospital Revenue Code	302
Min. Negotiated Rate	$55.55
Max. Negotiated Rate	$75.75
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: Health Smart Auto/Commercial	$60.60
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 Beech St/Commercial/PHCS	$75.75

HC LAB REF ANTI-PM1 AB

Facility

$101.00

Service Code	CPT 86235 90
Hospital Charge Code	900911424
Hospital Revenue Code	302
Min. Negotiated Rate	$55.55
Max. Negotiated Rate	$80.80
Rate for Payer: Cash Price	$45.45
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$75.75

HC LAB REF ASPERGILLUS AB

Facility

$45.00

Service Code	CPT 86606
Hospital Charge Code	900911117
Hospital Revenue Code	302
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$36.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Cigna of CA HMO/PPO	$36.00
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC LAB REF ASPERGILLUS AB

Facility

$45.00

Service Code	CPT 86606 90
Hospital Charge Code	900911117
Hospital Revenue Code	302
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.00
Rate for Payer: Aetna of CA Government/Medicare	$27.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC LAB REF ASPERGILLUS AB

Facility

$45.00

Service Code	CPT 86606 90
Hospital Charge Code	900911117
Hospital Revenue Code	302
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$36.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Cigna of CA HMO/PPO	$36.00
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC LAB REF ASPERGILLUS AB

Facility

$45.00

Service Code	CPT 86606
Hospital Charge Code	900911117
Hospital Revenue Code	302
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.00
Rate for Payer: Aetna of CA Government/Medicare	$27.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC LAB REF BIOTINADASE

Facility

$27.00

Service Code	CPT 82261 90
Hospital Charge Code	900910727
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$20.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.20
Rate for Payer: Aetna of CA Government/Medicare	$16.20
Rate for Payer: Cash Price	$12.15
Rate for Payer: Health Smart Auto/Commercial	$16.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.20
Rate for Payer: LLUH Dept of Risk Management WC	$14.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.25

HC LAB REF BIOTINADASE

Facility

$27.00

Service Code	CPT 82261
Hospital Charge Code	900910727
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$20.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.20
Rate for Payer: Aetna of CA Government/Medicare	$16.20
Rate for Payer: Cash Price	$12.15
Rate for Payer: Health Smart Auto/Commercial	$16.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.20
Rate for Payer: LLUH Dept of Risk Management WC	$14.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.25

Know your out-of-pocket cost for care.

All Charges