Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC LAB REF HSV 2 IGG

Facility

$16.00

Service Code	CPT 86696 90
Hospital Charge Code	900911469
Hospital Revenue Code	306
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.60
Rate for Payer: Aetna of CA Government/Medicare	$9.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Smart Auto/Commercial	$9.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.60
Rate for Payer: LLUH Dept of Risk Management WC	$8.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.00

HC LAB REF HSV 2 IGG

Facility

$16.00

Service Code	CPT 86696
Hospital Charge Code	900911469
Hospital Revenue Code	306
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.60
Rate for Payer: Aetna of CA Government/Medicare	$9.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Smart Auto/Commercial	$9.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.60
Rate for Payer: LLUH Dept of Risk Management WC	$8.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.00

HC LAB REF HSV PCR

Facility

$218.00

Service Code	CPT 87529
Hospital Charge Code	900910770
Hospital Revenue Code	306
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$174.40
Rate for Payer: Cash Price	$98.10
Rate for Payer: Cigna of CA HMO/PPO	$174.40
Rate for Payer: Health Smart Auto/Commercial	$130.80
Rate for Payer: LLUH Dept of Risk Management WC	$119.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$163.50

HC LAB REF HSV PCR

Facility

$218.00

Service Code	CPT 87529
Hospital Charge Code	900910770
Hospital Revenue Code	306
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$163.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$130.80
Rate for Payer: Aetna of CA Government/Medicare	$130.80
Rate for Payer: Cash Price	$98.10
Rate for Payer: Health Smart Auto/Commercial	$130.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$130.80
Rate for Payer: LLUH Dept of Risk Management WC	$119.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$163.50

HC LAB REF HSV PCR

Facility

$218.00

Service Code	CPT 87529 90
Hospital Charge Code	900910770
Hospital Revenue Code	306
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$163.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$130.80
Rate for Payer: Aetna of CA Government/Medicare	$130.80
Rate for Payer: Cash Price	$98.10
Rate for Payer: Health Smart Auto/Commercial	$130.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$130.80
Rate for Payer: LLUH Dept of Risk Management WC	$119.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$163.50

HC LAB REF HSV PCR

Facility

$218.00

Service Code	CPT 87529 90
Hospital Charge Code	900910770
Hospital Revenue Code	306
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$174.40
Rate for Payer: Cash Price	$98.10
Rate for Payer: Cigna of CA HMO/PPO	$174.40
Rate for Payer: Health Smart Auto/Commercial	$130.80
Rate for Payer: LLUH Dept of Risk Management WC	$119.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$163.50

HC LAB REF HYDROMORPHONE

Facility

$223.00

Service Code	CPT 80361
Hospital Charge Code	900910753
Hospital Revenue Code	301
Min. Negotiated Rate	$122.65
Max. Negotiated Rate	$167.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$133.80
Rate for Payer: Aetna of CA Government/Medicare	$133.80
Rate for Payer: Cash Price	$100.35
Rate for Payer: Health Smart Auto/Commercial	$133.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$133.80
Rate for Payer: LLUH Dept of Risk Management WC	$122.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$167.25

HC LAB REF HYDROMORPHONE

Facility

$223.00

Service Code	CPT G0480 90
Hospital Charge Code	900910753
Hospital Revenue Code	301
Min. Negotiated Rate	$122.65
Max. Negotiated Rate	$178.40
Rate for Payer: Cash Price	$100.35
Rate for Payer: Cigna of CA HMO/PPO	$178.40
Rate for Payer: Health Smart Auto/Commercial	$133.80
Rate for Payer: LLUH Dept of Risk Management WC	$122.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$167.25

HC LAB REF HYDROMORPHONE

Facility

$223.00

Service Code	CPT G0480
Hospital Charge Code	900910753
Hospital Revenue Code	301
Min. Negotiated Rate	$122.65
Max. Negotiated Rate	$178.40
Rate for Payer: Cash Price	$100.35
Rate for Payer: Cigna of CA HMO/PPO	$178.40
Rate for Payer: Health Smart Auto/Commercial	$133.80
Rate for Payer: LLUH Dept of Risk Management WC	$122.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$167.25

HC LAB REF HYDROMORPHONE

Facility

$223.00

Service Code	CPT G0480 90
Hospital Charge Code	900910753
Hospital Revenue Code	301
Min. Negotiated Rate	$122.65
Max. Negotiated Rate	$167.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$133.80
Rate for Payer: Aetna of CA Government/Medicare	$133.80
Rate for Payer: Cash Price	$100.35
Rate for Payer: Health Smart Auto/Commercial	$133.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$133.80
Rate for Payer: LLUH Dept of Risk Management WC	$122.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$167.25

HC LAB REF HYDROMORPHONE

Facility

$223.00

Service Code	CPT 80361
Hospital Charge Code	900910753
Hospital Revenue Code	301
Min. Negotiated Rate	$122.65
Max. Negotiated Rate	$178.40
Rate for Payer: Cash Price	$100.35
Rate for Payer: Cigna of CA HMO/PPO	$178.40
Rate for Payer: Health Smart Auto/Commercial	$133.80
Rate for Payer: LLUH Dept of Risk Management WC	$122.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$167.25

HC LAB REF HYDROMORPHONE

Facility

$223.00

Service Code	CPT G0480
Hospital Charge Code	900910753
Hospital Revenue Code	301
Min. Negotiated Rate	$122.65
Max. Negotiated Rate	$167.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$133.80
Rate for Payer: Aetna of CA Government/Medicare	$133.80
Rate for Payer: Cash Price	$100.35
Rate for Payer: Health Smart Auto/Commercial	$133.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$133.80
Rate for Payer: LLUH Dept of Risk Management WC	$122.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$167.25

HC LAB REF IGF-BP2

Facility

$67.00

Service Code	CPT 83519
Hospital Charge Code	900911427
Hospital Revenue Code	301
Min. Negotiated Rate	$36.85
Max. Negotiated Rate	$53.60
Rate for Payer: Cash Price	$30.15
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$50.25

HC LAB REF IGF-BP2

Facility

$67.00

Service Code	CPT 83519
Hospital Charge Code	900911427
Hospital Revenue Code	301
Min. Negotiated Rate	$36.85
Max. Negotiated Rate	$50.25
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: Health Smart Auto/Commercial	$40.20
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 Beech St/Commercial/PHCS	$50.25

HC LAB REF IGF-BP2

Facility

$67.00

Service Code	CPT 83519 90
Hospital Charge Code	900911427
Hospital Revenue Code	301
Min. Negotiated Rate	$36.85
Max. Negotiated Rate	$53.60
Rate for Payer: Cash Price	$30.15
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$50.25

HC LAB REF IGF-BP2

Facility

$67.00

Service Code	CPT 83519 90
Hospital Charge Code	900911427
Hospital Revenue Code	301
Min. Negotiated Rate	$36.85
Max. Negotiated Rate	$50.25
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: Health Smart Auto/Commercial	$40.20
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 Beech St/Commercial/PHCS	$50.25

HC LAB REF IMMUNE COMPLEX PANEL C3D

Facility

$81.00

Service Code	CPT 86332
Hospital Charge Code	900912837
Hospital Revenue Code	302
Min. Negotiated Rate	$44.55
Max. Negotiated Rate	$64.80
Rate for Payer: Cash Price	$36.45
Rate for Payer: Cigna of CA HMO/PPO	$64.80
Rate for Payer: Health Smart Auto/Commercial	$48.60
Rate for Payer: LLUH Dept of Risk Management WC	$44.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$60.75

HC LAB REF IMMUNE COMPLEX PANEL C3D

Facility

$81.00

Service Code	CPT 86332 90
Hospital Charge Code	900912837
Hospital Revenue Code	302
Min. Negotiated Rate	$44.55
Max. Negotiated Rate	$64.80
Rate for Payer: Cash Price	$36.45
Rate for Payer: Cigna of CA HMO/PPO	$64.80
Rate for Payer: Health Smart Auto/Commercial	$48.60
Rate for Payer: LLUH Dept of Risk Management WC	$44.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$60.75

HC LAB REF IMMUNE COMPLEX PANEL C3D

Facility

$81.00

Service Code	CPT 86332
Hospital Charge Code	900912837
Hospital Revenue Code	302
Min. Negotiated Rate	$44.55
Max. Negotiated Rate	$60.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$48.60
Rate for Payer: Aetna of CA Government/Medicare	$48.60
Rate for Payer: Cash Price	$36.45
Rate for Payer: Health Smart Auto/Commercial	$48.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$48.60
Rate for Payer: LLUH Dept of Risk Management WC	$44.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$60.75

HC LAB REF IMMUNE COMPLEX PANEL C3D

Facility

$81.00

Service Code	CPT 86332 90
Hospital Charge Code	900912837
Hospital Revenue Code	302
Min. Negotiated Rate	$44.55
Max. Negotiated Rate	$60.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$48.60
Rate for Payer: Aetna of CA Government/Medicare	$48.60
Rate for Payer: Cash Price	$36.45
Rate for Payer: Health Smart Auto/Commercial	$48.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$48.60
Rate for Payer: LLUH Dept of Risk Management WC	$44.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$60.75

HC LAB REF IMMUNO FIXATION ELECTROPHORESI

Facility

$179.00

Service Code	CPT 86334
Hospital Charge Code	900912722
Hospital Revenue Code	301
Min. Negotiated Rate	$98.45
Max. Negotiated Rate	$134.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$107.40
Rate for Payer: Aetna of CA Government/Medicare	$107.40
Rate for Payer: Cash Price	$80.55
Rate for Payer: Health Smart Auto/Commercial	$107.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$107.40
Rate for Payer: LLUH Dept of Risk Management WC	$98.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$134.25

HC LAB REF IMMUNO FIXATION ELECTROPHORESI

Facility

$179.00

Service Code	CPT 86334 90
Hospital Charge Code	900912722
Hospital Revenue Code	301
Min. Negotiated Rate	$98.45
Max. Negotiated Rate	$143.20
Rate for Payer: Cash Price	$80.55
Rate for Payer: Cigna of CA HMO/PPO	$143.20
Rate for Payer: Health Smart Auto/Commercial	$107.40
Rate for Payer: LLUH Dept of Risk Management WC	$98.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$134.25

HC LAB REF IMMUNO FIXATION ELECTROPHORESI

Facility

$179.00

Service Code	CPT 86334
Hospital Charge Code	900912722
Hospital Revenue Code	301
Min. Negotiated Rate	$98.45
Max. Negotiated Rate	$143.20
Rate for Payer: Cash Price	$80.55
Rate for Payer: Cigna of CA HMO/PPO	$143.20
Rate for Payer: Health Smart Auto/Commercial	$107.40
Rate for Payer: LLUH Dept of Risk Management WC	$98.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$134.25

HC LAB REF IMMUNO FIXATION ELECTROPHORESI

Facility

$179.00

Service Code	CPT 86334 90
Hospital Charge Code	900912722
Hospital Revenue Code	301
Min. Negotiated Rate	$98.45
Max. Negotiated Rate	$134.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$107.40
Rate for Payer: Aetna of CA Government/Medicare	$107.40
Rate for Payer: Cash Price	$80.55
Rate for Payer: Health Smart Auto/Commercial	$107.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$107.40
Rate for Payer: LLUH Dept of Risk Management WC	$98.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$134.25

HC LAB REF IMMUNO FIXATION ELECTRO UR

Facility

$47.00

Service Code	CPT 86335 90
Hospital Charge Code	900912719
Hospital Revenue Code	301
Min. Negotiated Rate	$25.85
Max. Negotiated Rate	$37.60
Rate for Payer: Cash Price	$21.15
Rate for Payer: Cigna of CA HMO/PPO	$37.60
Rate for Payer: Health Smart Auto/Commercial	$28.20
Rate for Payer: LLUH Dept of Risk Management WC	$25.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$35.25

Know your out-of-pocket cost for care.

All Charges