Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC LAB REF MS PANEL IGG CSF

Facility

$15.00

Service Code	CPT 82784
Hospital Charge Code	900910556
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.00
Rate for Payer: Aetna of CA Government/Medicare	$9.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC LAB REF MS PANEL IGG CSF

Facility

$15.00

Service Code	CPT 82784 90
Hospital Charge Code	900910556
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.00
Rate for Payer: Aetna of CA Government/Medicare	$9.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC LAB REF MS PANEL IGG CSF

Facility

$15.00

Service Code	CPT 82784
Hospital Charge Code	900910556
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$12.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Cigna of CA HMO/PPO	$12.00
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC LAB REF MS PANEL IGG CSF

Facility

$15.00

Service Code	CPT 82784 90
Hospital Charge Code	900910556
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$12.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Cigna of CA HMO/PPO	$12.00
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC LAB REF MS PANEL IGG, SERUM

Facility

$15.00

Service Code	CPT 82784 90
Hospital Charge Code	900912659
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$12.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Cigna of CA HMO/PPO	$12.00
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC LAB REF MS PANEL IGG, SERUM

Facility

$15.00

Service Code	CPT 82784
Hospital Charge Code	900912659
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$12.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Cigna of CA HMO/PPO	$12.00
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC LAB REF MS PANEL IGG, SERUM

Facility

$15.00

Service Code	CPT 82784
Hospital Charge Code	900912659
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.00
Rate for Payer: Aetna of CA Government/Medicare	$9.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC LAB REF MS PANEL IGG, SERUM

Facility

$15.00

Service Code	CPT 82784 90
Hospital Charge Code	900912659
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.00
Rate for Payer: Aetna of CA Government/Medicare	$9.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC LAB REF MTHFR MUTATION

Facility

$63.00

Service Code	CPT 81291
Hospital Charge Code	900912713
Hospital Revenue Code	310
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$47.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$37.80
Rate for Payer: Aetna of CA Government/Medicare	$37.80
Rate for Payer: Cash Price	$28.35
Rate for Payer: Health Smart Auto/Commercial	$37.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$37.80
Rate for Payer: LLUH Dept of Risk Management WC	$34.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$47.25

HC LAB REF MTHFR MUTATION

Facility

$63.00

Service Code	CPT 81291 90
Hospital Charge Code	900912713
Hospital Revenue Code	310
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$47.25
Rate for Payer: Health Smart Auto/Commercial	$37.80
Rate for Payer: Cash Price	$28.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$37.80
Rate for Payer: Aetna of CA Government/Medicare	$37.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$37.80
Rate for Payer: LLUH Dept of Risk Management WC	$34.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$47.25

HC LAB REF MTHFR MUTATION

Facility

$63.00

Service Code	CPT 81291 90
Hospital Charge Code	900912713
Hospital Revenue Code	310
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$50.40
Rate for Payer: Cash Price	$28.35
Rate for Payer: Cigna of CA HMO/PPO	$50.40
Rate for Payer: Health Smart Auto/Commercial	$37.80
Rate for Payer: LLUH Dept of Risk Management WC	$34.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$47.25

HC LAB REF MTHFR MUTATION

Facility

$63.00

Service Code	CPT 81291
Hospital Charge Code	900912713
Hospital Revenue Code	310
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$50.40
Rate for Payer: Cash Price	$28.35
Rate for Payer: Cigna of CA HMO/PPO	$50.40
Rate for Payer: Health Smart Auto/Commercial	$37.80
Rate for Payer: LLUH Dept of Risk Management WC	$34.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$47.25

HC LAB REF MUMPS AB IGG

Facility

$21.00

Service Code	CPT 86735 90
Hospital Charge Code	900910544
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 MUMPS AB IGG

Facility

$21.00

Service Code	CPT 86735
Hospital Charge Code	900910544
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 MUMPS AB IGG

Facility

$21.00

Service Code	CPT 86735
Hospital Charge Code	900910544
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 MUMPS AB IGG

Facility

$21.00

Service Code	CPT 86735 90
Hospital Charge Code	900910544
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 MUMPS AB IGM

Facility

$21.00

Service Code	CPT 86735 90
Hospital Charge Code	900912693
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 MUMPS AB IGM

Facility

$21.00

Service Code	CPT 86735 90
Hospital Charge Code	900912693
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 MUMPS AB IGM

Facility

$21.00

Service Code	CPT 86735
Hospital Charge Code	900912693
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 MUMPS AB IGM

Facility

$21.00

Service Code	CPT 86735
Hospital Charge Code	900912693
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 NEISSERIA GONORRHOEAE AB

Facility

$100.00

Service Code	CPT 86609 90
Hospital Charge Code	900911592
Hospital Revenue Code	302
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$60.00
Rate for Payer: Aetna of CA Government/Medicare	$60.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Smart Auto/Commercial	$60.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$60.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$75.00

HC LAB REF NEISSERIA GONORRHOEAE AB

Facility

$100.00

Service Code	CPT 86609
Hospital Charge Code	900911592
Hospital Revenue Code	302
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$80.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna of CA HMO/PPO	$80.00
Rate for Payer: Health Smart Auto/Commercial	$60.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$75.00

HC LAB REF NEISSERIA GONORRHOEAE AB

Facility

$100.00

Service Code	CPT 86609
Hospital Charge Code	900911592
Hospital Revenue Code	302
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$75.00
Rate for Payer: Health Smart Auto/Commercial	$60.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$60.00
Rate for Payer: Aetna of CA Government/Medicare	$60.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$60.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$75.00

HC LAB REF NEISSERIA GONORRHOEAE AB

Facility

$100.00

Service Code	CPT 86609 90
Hospital Charge Code	900911592
Hospital Revenue Code	302
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$80.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna of CA HMO/PPO	$80.00
Rate for Payer: Health Smart Auto/Commercial	$60.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$75.00

HC LAB REF NEUTROPHIL OXIDATIVE BURST

Facility

$47.00

Service Code	CPT 82657 90
Hospital Charge Code	900912536
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