Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC LAB REF MITOCHONDRIAL DNA

Facility

$1,316.00

Service Code	CPT 84999
Hospital Charge Code	900911407
Hospital Revenue Code	302
Min. Negotiated Rate	$723.80
Max. Negotiated Rate	$987.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$789.60
Rate for Payer: Aetna of CA Government/Medicare	$789.60
Rate for Payer: Cash Price	$592.20
Rate for Payer: Health Smart Auto/Commercial	$789.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$789.60
Rate for Payer: LLUH Dept of Risk Management WC	$723.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$987.00

HC LAB REF MMR MUMPS IGG IFA

Facility

$54.00

Service Code	CPT 86735 90
Hospital Charge Code	900912870
Hospital Revenue Code	302
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$43.20
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$40.50

HC LAB REF MMR MUMPS IGG IFA

Facility

$54.00

Service Code	CPT 86735 90
Hospital Charge Code	900912870
Hospital Revenue Code	302
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$40.50
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: 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 Beech St/Commercial/PHCS	$40.50

HC LAB REF MMR MUMPS IGG IFA

Facility

$54.00

Service Code	CPT 86735
Hospital Charge Code	900912870
Hospital Revenue Code	302
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$40.50
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: 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 Beech St/Commercial/PHCS	$40.50

HC LAB REF MMR MUMPS IGG IFA

Facility

$54.00

Service Code	CPT 86735
Hospital Charge Code	900912870
Hospital Revenue Code	302
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$43.20
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$40.50

HC LAB REF MMR RUBELLA IGG ELISA

Facility

$60.00

Service Code	CPT 86762
Hospital Charge Code	900912871
Hospital Revenue Code	302
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$48.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna of CA HMO/PPO	$48.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.00

HC LAB REF MMR RUBELLA IGG ELISA

Facility

$60.00

Service Code	CPT 86762 90
Hospital Charge Code	900912871
Hospital Revenue Code	302
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$36.00
Rate for Payer: Aetna of CA Government/Medicare	$36.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.00

HC LAB REF MMR RUBELLA IGG ELISA

Facility

$60.00

Service Code	CPT 86762
Hospital Charge Code	900912871
Hospital Revenue Code	302
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$36.00
Rate for Payer: Aetna of CA Government/Medicare	$36.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.00

HC LAB REF MMR RUBELLA IGG ELISA

Facility

$60.00

Service Code	CPT 86762 90
Hospital Charge Code	900912871
Hospital Revenue Code	302
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$48.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna of CA HMO/PPO	$48.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.00

HC LAB REF MMR RUBEOLA IGG IFA

Facility

$53.00

Service Code	CPT 86765
Hospital Charge Code	900912869
Hospital Revenue Code	302
Min. Negotiated Rate	$29.15
Max. Negotiated Rate	$39.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$31.80
Rate for Payer: Aetna of CA Government/Medicare	$31.80
Rate for Payer: Cash Price	$23.85
Rate for Payer: Health Smart Auto/Commercial	$31.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$31.80
Rate for Payer: LLUH Dept of Risk Management WC	$29.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$39.75

HC LAB REF MMR RUBEOLA IGG IFA

Facility

$53.00

Service Code	CPT 86765 90
Hospital Charge Code	900912869
Hospital Revenue Code	302
Min. Negotiated Rate	$29.15
Max. Negotiated Rate	$42.40
Rate for Payer: Cash Price	$23.85
Rate for Payer: Cigna of CA HMO/PPO	$42.40
Rate for Payer: Health Smart Auto/Commercial	$31.80
Rate for Payer: LLUH Dept of Risk Management WC	$29.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$39.75

HC LAB REF MMR RUBEOLA IGG IFA

Facility

$53.00

Service Code	CPT 86765
Hospital Charge Code	900912869
Hospital Revenue Code	302
Min. Negotiated Rate	$29.15
Max. Negotiated Rate	$42.40
Rate for Payer: Cash Price	$23.85
Rate for Payer: Cigna of CA HMO/PPO	$42.40
Rate for Payer: Health Smart Auto/Commercial	$31.80
Rate for Payer: LLUH Dept of Risk Management WC	$29.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$39.75

HC LAB REF MMR RUBEOLA IGG IFA

Facility

$53.00

Service Code	CPT 86765 90
Hospital Charge Code	900912869
Hospital Revenue Code	302
Min. Negotiated Rate	$29.15
Max. Negotiated Rate	$39.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$31.80
Rate for Payer: Aetna of CA Government/Medicare	$31.80
Rate for Payer: Cash Price	$23.85
Rate for Payer: Health Smart Auto/Commercial	$31.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$31.80
Rate for Payer: LLUH Dept of Risk Management WC	$29.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$39.75

HC LAB REF MOLECULAR CYTOGENETICS,DNA PRO

Facility

$34.00

Service Code	CPT 88271
Hospital Charge Code	900910683
Hospital Revenue Code	310
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.40
Rate for Payer: Aetna of CA Government/Medicare	$20.40
Rate for Payer: Cash Price	$15.30
Rate for Payer: Health Smart Auto/Commercial	$20.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.40
Rate for Payer: LLUH Dept of Risk Management WC	$18.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.50

HC LAB REF MOLECULAR CYTOGENETICS,DNA PRO

Facility

$34.00

Service Code	CPT 88271 90,TC
Hospital Charge Code	900910683
Hospital Revenue Code	310
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.40
Rate for Payer: Aetna of CA Government/Medicare	$20.40
Rate for Payer: Cash Price	$15.30
Rate for Payer: Health Smart Auto/Commercial	$20.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.40
Rate for Payer: LLUH Dept of Risk Management WC	$18.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.50

HC LAB REF MOLECULAR CYTOGENETICS,DNA PRO

Facility

$34.00

Service Code	CPT 88271
Hospital Charge Code	900910683
Hospital Revenue Code	310
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$27.20
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cigna of CA HMO/PPO	$27.20
Rate for Payer: Health Smart Auto/Commercial	$20.40
Rate for Payer: LLUH Dept of Risk Management WC	$18.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.50

HC LAB REF MOLECULAR CYTOGENETICS,DNA PRO

Facility

$34.00

Service Code	CPT 88271 90,TC
Hospital Charge Code	900910683
Hospital Revenue Code	310
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$27.20
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cigna of CA HMO/PPO	$27.20
Rate for Payer: Health Smart Auto/Commercial	$20.40
Rate for Payer: LLUH Dept of Risk Management WC	$18.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.50

HC LAB REF MOLECULAR CYTOGENTCS 100-300CE

Facility

$64.00

Service Code	CPT 88275
Hospital Charge Code	900910679
Hospital Revenue Code	310
Min. Negotiated Rate	$35.20
Max. Negotiated Rate	$51.20
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cigna of CA HMO/PPO	$51.20
Rate for Payer: Health Smart Auto/Commercial	$38.40
Rate for Payer: LLUH Dept of Risk Management WC	$35.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$48.00

HC LAB REF MOLECULAR CYTOGENTCS 100-300CE

Facility

$64.00

Service Code	CPT 88275 90,TC
Hospital Charge Code	900910679
Hospital Revenue Code	310
Min. Negotiated Rate	$35.20
Max. Negotiated Rate	$48.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$38.40
Rate for Payer: Aetna of CA Government/Medicare	$38.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Smart Auto/Commercial	$38.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$38.40
Rate for Payer: LLUH Dept of Risk Management WC	$35.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$48.00

HC LAB REF MOLECULAR CYTOGENTCS 100-300CE

Facility

$64.00

Service Code	CPT 88275 90,TC
Hospital Charge Code	900910679
Hospital Revenue Code	310
Min. Negotiated Rate	$35.20
Max. Negotiated Rate	$51.20
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cigna of CA HMO/PPO	$51.20
Rate for Payer: Health Smart Auto/Commercial	$38.40
Rate for Payer: LLUH Dept of Risk Management WC	$35.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$48.00

HC LAB REF MOLECULAR CYTOGENTCS 100-300CE

Facility

$64.00

Service Code	CPT 88275
Hospital Charge Code	900910679
Hospital Revenue Code	310
Min. Negotiated Rate	$35.20
Max. Negotiated Rate	$48.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$38.40
Rate for Payer: Aetna of CA Government/Medicare	$38.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Smart Auto/Commercial	$38.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$38.40
Rate for Payer: LLUH Dept of Risk Management WC	$35.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$48.00

HC LAB REF MORPHOMETRIC ANALYSIS IN SITU

Facility

$73.00

Service Code	CPT 88368 90
Hospital Charge Code	900912796
Hospital Revenue Code	310
Min. Negotiated Rate	$40.15
Max. Negotiated Rate	$54.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$43.80
Rate for Payer: Aetna of CA Government/Medicare	$43.80
Rate for Payer: Cash Price	$32.85
Rate for Payer: Health Smart Auto/Commercial	$43.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$43.80
Rate for Payer: LLUH Dept of Risk Management WC	$40.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$54.75

HC LAB REF MORPHOMETRIC ANALYSIS IN SITU

Facility

$73.00

Service Code	CPT 88368
Hospital Charge Code	900912796
Hospital Revenue Code	310
Min. Negotiated Rate	$40.15
Max. Negotiated Rate	$58.40
Rate for Payer: Cash Price	$32.85
Rate for Payer: Cigna of CA HMO/PPO	$58.40
Rate for Payer: Health Smart Auto/Commercial	$43.80
Rate for Payer: LLUH Dept of Risk Management WC	$40.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$54.75

HC LAB REF MORPHOMETRIC ANALYSIS IN SITU

Facility

$73.00

Service Code	CPT 88368
Hospital Charge Code	900912796
Hospital Revenue Code	310
Min. Negotiated Rate	$40.15
Max. Negotiated Rate	$54.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$43.80
Rate for Payer: Aetna of CA Government/Medicare	$43.80
Rate for Payer: Cash Price	$32.85
Rate for Payer: Health Smart Auto/Commercial	$43.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$43.80
Rate for Payer: LLUH Dept of Risk Management WC	$40.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$54.75

HC LAB REF MORPHOMETRIC ANALYSIS IN SITU

Facility

$73.00

Service Code	CPT 88368 90
Hospital Charge Code	900912796
Hospital Revenue Code	310
Min. Negotiated Rate	$40.15
Max. Negotiated Rate	$58.40
Rate for Payer: Cash Price	$32.85
Rate for Payer: Cigna of CA HMO/PPO	$58.40
Rate for Payer: Health Smart Auto/Commercial	$43.80
Rate for Payer: LLUH Dept of Risk Management WC	$40.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$54.75

Know your out-of-pocket cost for care.

All Charges