Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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	$21.60
Rate for Payer: Cash Price	$12.15
Rate for Payer: Cigna of CA HMO/PPO	$21.60
Rate for Payer: Health Smart Auto/Commercial	$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 BK VIRUS BY PCR

Facility

$56.00

Service Code	CPT 87798
Hospital Charge Code	900912606
Hospital Revenue Code	306
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$44.80
Rate for Payer: Cash Price	$25.20
Rate for Payer: Cigna of CA HMO/PPO	$44.80
Rate for Payer: Health Smart Auto/Commercial	$33.60
Rate for Payer: LLUH Dept of Risk Management WC	$30.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$42.00

HC LAB REF BK VIRUS BY PCR

Facility

$56.00

Service Code	CPT 87798 90
Hospital Charge Code	900912606
Hospital Revenue Code	306
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$42.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$33.60
Rate for Payer: Aetna of CA Government/Medicare	$33.60
Rate for Payer: Cash Price	$25.20
Rate for Payer: Health Smart Auto/Commercial	$33.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$33.60
Rate for Payer: LLUH Dept of Risk Management WC	$30.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$42.00

HC LAB REF BK VIRUS BY PCR

Facility

$56.00

Service Code	CPT 87798 90
Hospital Charge Code	900912606
Hospital Revenue Code	306
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$44.80
Rate for Payer: Cash Price	$25.20
Rate for Payer: Cigna of CA HMO/PPO	$44.80
Rate for Payer: Health Smart Auto/Commercial	$33.60
Rate for Payer: LLUH Dept of Risk Management WC	$30.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$42.00

HC LAB REF BK VIRUS BY PCR

Facility

$56.00

Service Code	CPT 87798
Hospital Charge Code	900912606
Hospital Revenue Code	306
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$42.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$33.60
Rate for Payer: Aetna of CA Government/Medicare	$33.60
Rate for Payer: Cash Price	$25.20
Rate for Payer: Health Smart Auto/Commercial	$33.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$33.60
Rate for Payer: LLUH Dept of Risk Management WC	$30.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$42.00

HC LAB REF BK VIRUS QUANT PCR, URINE

Facility

$69.00

Service Code	CPT 87799
Hospital Charge Code	900912695
Hospital Revenue Code	301
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$51.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$41.40
Rate for Payer: Aetna of CA Government/Medicare	$41.40
Rate for Payer: Cash Price	$31.05
Rate for Payer: Health Smart Auto/Commercial	$41.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$41.40
Rate for Payer: LLUH Dept of Risk Management WC	$37.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$51.75

HC LAB REF BK VIRUS QUANT PCR, URINE

Facility

$69.00

Service Code	CPT 87799 90
Hospital Charge Code	900912695
Hospital Revenue Code	301
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$55.20
Rate for Payer: Cash Price	$31.05
Rate for Payer: Cigna of CA HMO/PPO	$55.20
Rate for Payer: Health Smart Auto/Commercial	$41.40
Rate for Payer: LLUH Dept of Risk Management WC	$37.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$51.75

HC LAB REF BK VIRUS QUANT PCR, URINE

Facility

$69.00

Service Code	CPT 87799 90
Hospital Charge Code	900912695
Hospital Revenue Code	301
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$51.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$41.40
Rate for Payer: Aetna of CA Government/Medicare	$41.40
Rate for Payer: Cash Price	$31.05
Rate for Payer: Health Smart Auto/Commercial	$41.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$41.40
Rate for Payer: LLUH Dept of Risk Management WC	$37.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$51.75

HC LAB REF BK VIRUS QUANT PCR, URINE

Facility

$69.00

Service Code	CPT 87799
Hospital Charge Code	900912695
Hospital Revenue Code	301
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$55.20
Rate for Payer: Cash Price	$31.05
Rate for Payer: Cigna of CA HMO/PPO	$55.20
Rate for Payer: Health Smart Auto/Commercial	$41.40
Rate for Payer: LLUH Dept of Risk Management WC	$37.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$51.75

HC LAB REF CALCIUM RANDOM URINE

Facility

$10.00

Service Code	CPT 82340
Hospital Charge Code	900912784
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$7.50
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: Health Smart Auto/Commercial	$6.00
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 Beech St/Commercial/PHCS	$7.50

HC LAB REF CALCIUM RANDOM URINE

Facility

$10.00

Service Code	CPT 82340 90
Hospital Charge Code	900912784
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$7.50
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: Health Smart Auto/Commercial	$6.00
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 Beech St/Commercial/PHCS	$7.50

HC LAB REF CALCIUM RANDOM URINE

Facility

$10.00

Service Code	CPT 82340
Hospital Charge Code	900912784
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.00
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$7.50

HC LAB REF CALCIUM RANDOM URINE

Facility

$10.00

Service Code	CPT 82340 90
Hospital Charge Code	900912784
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.00
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$7.50

HC LAB REF CALCIUM URINE

Facility

$10.00

Service Code	CPT 82340
Hospital Charge Code	900910213
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.00
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$7.50

HC LAB REF CALCIUM URINE

Facility

$10.00

Service Code	CPT 82340 90
Hospital Charge Code	900910213
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$7.50
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: Health Smart Auto/Commercial	$6.00
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 Beech St/Commercial/PHCS	$7.50

HC LAB REF CALCIUM URINE

Facility

$10.00

Service Code	CPT 82340
Hospital Charge Code	900910213
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$7.50
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: Health Smart Auto/Commercial	$6.00
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 Beech St/Commercial/PHCS	$7.50

HC LAB REF CALCIUM URINE

Facility

$10.00

Service Code	CPT 82340 90
Hospital Charge Code	900910213
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.00
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$7.50

HC LAB REF CALIFORNIA ENCEPH AB IGG

Facility

$21.00

Service Code	CPT 86651 90
Hospital Charge Code	900911466
Hospital Revenue Code	302
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$15.75
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: Health Smart Auto/Commercial	$12.60
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 Beech St/Commercial/PHCS	$15.75

HC LAB REF CALIFORNIA ENCEPH AB IGG

Facility

$21.00

Service Code	CPT 86651 90
Hospital Charge Code	900911466
Hospital Revenue Code	302
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$16.80
Rate for Payer: Cash Price	$9.45
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$15.75

HC LAB REF CALIFORNIA ENCEPH AB IGG

Facility

$21.00

Service Code	CPT 86651
Hospital Charge Code	900911466
Hospital Revenue Code	302
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$16.80
Rate for Payer: Cash Price	$9.45
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$15.75

HC LAB REF CALIFORNIA ENCEPH AB IGG

Facility

$21.00

Service Code	CPT 86651
Hospital Charge Code	900911466
Hospital Revenue Code	302
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$15.75
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: Health Smart Auto/Commercial	$12.60
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 Beech St/Commercial/PHCS	$15.75

HC LAB REF CALIFORNIA ENCEPH AB IGM

Facility

$21.00

Service Code	CPT 86651 90
Hospital Charge Code	900912654
Hospital Revenue Code	302
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$15.75
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: Health Smart Auto/Commercial	$12.60
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 Beech St/Commercial/PHCS	$15.75

HC LAB REF CALIFORNIA ENCEPH AB IGM

Facility

$21.00

Service Code	CPT 86651
Hospital Charge Code	900912654
Hospital Revenue Code	302
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$15.75
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: Health Smart Auto/Commercial	$12.60
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 Beech St/Commercial/PHCS	$15.75

HC LAB REF CALIFORNIA ENCEPH AB IGM

Facility

$21.00

Service Code	CPT 86651 90
Hospital Charge Code	900912654
Hospital Revenue Code	302
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$16.80
Rate for Payer: Cash Price	$9.45
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$15.75

Know your out-of-pocket cost for care.

All Charges