Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC LAB REF NEUTROPHIL OXIDATIVE BURST

Facility

$47.00

Service Code	CPT 82657
Hospital Charge Code	900912536
Hospital Revenue Code	301
Min. Negotiated Rate	$25.85
Max. Negotiated Rate	$35.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$28.20
Rate for Payer: Aetna of CA Government/Medicare	$28.20
Rate for Payer: Cash Price	$21.15
Rate for Payer: Health Smart Auto/Commercial	$28.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$28.20
Rate for Payer: LLUH Dept of Risk Management WC	$25.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$35.25

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	$35.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$28.20
Rate for Payer: Aetna of CA Government/Medicare	$28.20
Rate for Payer: Cash Price	$21.15
Rate for Payer: Health Smart Auto/Commercial	$28.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$28.20
Rate for Payer: LLUH Dept of Risk Management WC	$25.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$35.25

HC LAB REF NEUTROPHIL OXIDATIVE BURST

Facility

$47.00

Service Code	CPT 82657
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

HC LAB REF PARAINFLUENZA AB TYPE 1

Facility

$33.00

Service Code	CPT 86790 90
Hospital Charge Code	900911773
Hospital Revenue Code	302
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$26.40
Rate for Payer: Cash Price	$14.85
Rate for Payer: Cigna of CA HMO/PPO	$26.40
Rate for Payer: Health Smart Auto/Commercial	$19.80
Rate for Payer: LLUH Dept of Risk Management WC	$18.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.75

HC LAB REF PARAINFLUENZA AB TYPE 1

Facility

$33.00

Service Code	CPT 86790
Hospital Charge Code	900911773
Hospital Revenue Code	302
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$26.40
Rate for Payer: Cash Price	$14.85
Rate for Payer: Cigna of CA HMO/PPO	$26.40
Rate for Payer: Health Smart Auto/Commercial	$19.80
Rate for Payer: LLUH Dept of Risk Management WC	$18.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.75

HC LAB REF PARAINFLUENZA AB TYPE 1

Facility

$33.00

Service Code	CPT 86790 90
Hospital Charge Code	900911773
Hospital Revenue Code	302
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$24.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.80
Rate for Payer: Aetna of CA Government/Medicare	$19.80
Rate for Payer: Cash Price	$14.85
Rate for Payer: Health Smart Auto/Commercial	$19.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.80
Rate for Payer: LLUH Dept of Risk Management WC	$18.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.75

HC LAB REF PARAINFLUENZA AB TYPE 1

Facility

$33.00

Service Code	CPT 86790
Hospital Charge Code	900911773
Hospital Revenue Code	302
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$24.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.80
Rate for Payer: Aetna of CA Government/Medicare	$19.80
Rate for Payer: Cash Price	$14.85
Rate for Payer: Health Smart Auto/Commercial	$19.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.80
Rate for Payer: LLUH Dept of Risk Management WC	$18.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.75

HC LAB REF PARAINFLUENZA AB TYPE 2

Facility

$33.00

Service Code	CPT 86790 90
Hospital Charge Code	900912838
Hospital Revenue Code	302
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$24.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.80
Rate for Payer: Aetna of CA Government/Medicare	$19.80
Rate for Payer: Cash Price	$14.85
Rate for Payer: Health Smart Auto/Commercial	$19.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.80
Rate for Payer: LLUH Dept of Risk Management WC	$18.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.75

HC LAB REF PARAINFLUENZA AB TYPE 2

Facility

$33.00

Service Code	CPT 86790
Hospital Charge Code	900912838
Hospital Revenue Code	302
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$26.40
Rate for Payer: Cash Price	$14.85
Rate for Payer: Cigna of CA HMO/PPO	$26.40
Rate for Payer: Health Smart Auto/Commercial	$19.80
Rate for Payer: LLUH Dept of Risk Management WC	$18.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.75

HC LAB REF PARAINFLUENZA AB TYPE 2

Facility

$33.00

Service Code	CPT 86790
Hospital Charge Code	900912838
Hospital Revenue Code	302
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$24.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.80
Rate for Payer: Aetna of CA Government/Medicare	$19.80
Rate for Payer: Cash Price	$14.85
Rate for Payer: Health Smart Auto/Commercial	$19.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.80
Rate for Payer: LLUH Dept of Risk Management WC	$18.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.75

HC LAB REF PARAINFLUENZA AB TYPE 2

Facility

$33.00

Service Code	CPT 86790 90
Hospital Charge Code	900912838
Hospital Revenue Code	302
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$26.40
Rate for Payer: Cash Price	$14.85
Rate for Payer: Cigna of CA HMO/PPO	$26.40
Rate for Payer: Health Smart Auto/Commercial	$19.80
Rate for Payer: LLUH Dept of Risk Management WC	$18.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.75

HC LAB REF PARAINFLUENZA AB TYPE 3

Facility

$33.00

Service Code	CPT 86790
Hospital Charge Code	900912839
Hospital Revenue Code	302
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$24.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.80
Rate for Payer: Aetna of CA Government/Medicare	$19.80
Rate for Payer: Cash Price	$14.85
Rate for Payer: Health Smart Auto/Commercial	$19.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.80
Rate for Payer: LLUH Dept of Risk Management WC	$18.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.75

HC LAB REF PARAINFLUENZA AB TYPE 3

Facility

$33.00

Service Code	CPT 86790
Hospital Charge Code	900912839
Hospital Revenue Code	302
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$26.40
Rate for Payer: Cash Price	$14.85
Rate for Payer: Cigna of CA HMO/PPO	$26.40
Rate for Payer: Health Smart Auto/Commercial	$19.80
Rate for Payer: LLUH Dept of Risk Management WC	$18.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.75

HC LAB REF PARAINFLUENZA AB TYPE 3

Facility

$33.00

Service Code	CPT 86790 90
Hospital Charge Code	900912839
Hospital Revenue Code	302
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$26.40
Rate for Payer: Cash Price	$14.85
Rate for Payer: Cigna of CA HMO/PPO	$26.40
Rate for Payer: Health Smart Auto/Commercial	$19.80
Rate for Payer: LLUH Dept of Risk Management WC	$18.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.75

HC LAB REF PARAINFLUENZA AB TYPE 3

Facility

$33.00

Service Code	CPT 86790 90
Hospital Charge Code	900912839
Hospital Revenue Code	302
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$24.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.80
Rate for Payer: Aetna of CA Government/Medicare	$19.80
Rate for Payer: Cash Price	$14.85
Rate for Payer: Health Smart Auto/Commercial	$19.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.80
Rate for Payer: LLUH Dept of Risk Management WC	$18.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.75

HC LAB REF PENTOBARBITAL

Facility

$181.00

Service Code	CPT 80345
Hospital Charge Code	900911216
Hospital Revenue Code	301
Min. Negotiated Rate	$99.55
Max. Negotiated Rate	$135.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$108.60
Rate for Payer: Aetna of CA Government/Medicare	$108.60
Rate for Payer: Cash Price	$81.45
Rate for Payer: Health Smart Auto/Commercial	$108.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$108.60
Rate for Payer: LLUH Dept of Risk Management WC	$99.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$135.75

HC LAB REF PENTOBARBITAL

Facility

$181.00

Service Code	CPT G0480
Hospital Charge Code	900911216
Hospital Revenue Code	301
Min. Negotiated Rate	$99.55
Max. Negotiated Rate	$144.80
Rate for Payer: Cash Price	$81.45
Rate for Payer: Cigna of CA HMO/PPO	$144.80
Rate for Payer: Health Smart Auto/Commercial	$108.60
Rate for Payer: LLUH Dept of Risk Management WC	$99.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$135.75

HC LAB REF PENTOBARBITAL

Facility

$181.00

Service Code	CPT 80345
Hospital Charge Code	900911216
Hospital Revenue Code	301
Min. Negotiated Rate	$99.55
Max. Negotiated Rate	$144.80
Rate for Payer: Cash Price	$81.45
Rate for Payer: Cigna of CA HMO/PPO	$144.80
Rate for Payer: Health Smart Auto/Commercial	$108.60
Rate for Payer: LLUH Dept of Risk Management WC	$99.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$135.75

HC LAB REF PENTOBARBITAL

Facility

$181.00

Service Code	CPT G0480 90
Hospital Charge Code	900911216
Hospital Revenue Code	301
Min. Negotiated Rate	$99.55
Max. Negotiated Rate	$135.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$108.60
Rate for Payer: Aetna of CA Government/Medicare	$108.60
Rate for Payer: Cash Price	$81.45
Rate for Payer: Health Smart Auto/Commercial	$108.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$108.60
Rate for Payer: LLUH Dept of Risk Management WC	$99.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$135.75

HC LAB REF PENTOBARBITAL

Facility

$181.00

Service Code	CPT G0480 90
Hospital Charge Code	900911216
Hospital Revenue Code	301
Min. Negotiated Rate	$99.55
Max. Negotiated Rate	$144.80
Rate for Payer: Cash Price	$81.45
Rate for Payer: Cigna of CA HMO/PPO	$144.80
Rate for Payer: Health Smart Auto/Commercial	$108.60
Rate for Payer: LLUH Dept of Risk Management WC	$99.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$135.75

HC LAB REF PENTOBARBITAL

Facility

$181.00

Service Code	CPT G0480
Hospital Charge Code	900911216
Hospital Revenue Code	301
Min. Negotiated Rate	$99.55
Max. Negotiated Rate	$135.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$108.60
Rate for Payer: Aetna of CA Government/Medicare	$108.60
Rate for Payer: Cash Price	$81.45
Rate for Payer: Health Smart Auto/Commercial	$108.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$108.60
Rate for Payer: LLUH Dept of Risk Management WC	$99.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$135.75

HC LAB REF PHOSPHOTIDYLSERINE IGA

Facility

$49.00

Service Code	CPT 86148
Hospital Charge Code	900911381
Hospital Revenue Code	301
Min. Negotiated Rate	$26.95
Max. Negotiated Rate	$36.75
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: Cash Price	$22.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$29.40
Rate for Payer: Aetna of CA Government/Medicare	$29.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$29.40
Rate for Payer: LLUH Dept of Risk Management WC	$26.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.75

HC LAB REF PHOSPHOTIDYLSERINE IGA

Facility

$49.00

Service Code	CPT 86148 90
Hospital Charge Code	900911381
Hospital Revenue Code	301
Min. Negotiated Rate	$26.95
Max. Negotiated Rate	$39.20
Rate for Payer: Cash Price	$22.05
Rate for Payer: Cigna of CA HMO/PPO	$39.20
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: LLUH Dept of Risk Management WC	$26.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.75

HC LAB REF PHOSPHOTIDYLSERINE IGA

Facility

$49.00

Service Code	CPT 86148
Hospital Charge Code	900911381
Hospital Revenue Code	301
Min. Negotiated Rate	$26.95
Max. Negotiated Rate	$39.20
Rate for Payer: Cash Price	$22.05
Rate for Payer: Cigna of CA HMO/PPO	$39.20
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: LLUH Dept of Risk Management WC	$26.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.75

HC LAB REF PHOSPHOTIDYLSERINE IGA

Facility

$49.00

Service Code	CPT 86148 90
Hospital Charge Code	900911381
Hospital Revenue Code	301
Min. Negotiated Rate	$26.95
Max. Negotiated Rate	$36.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$29.40
Rate for Payer: Aetna of CA Government/Medicare	$29.40
Rate for Payer: Cash Price	$22.05
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$29.40
Rate for Payer: LLUH Dept of Risk Management WC	$26.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.75

Know your out-of-pocket cost for care.

All Charges