Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC LAB REF RISPERIDONE

Facility

$96.00

Service Code	CPT 80342
Hospital Charge Code	900910787
Hospital Revenue Code	301
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$57.60
Rate for Payer: Aetna of CA Government/Medicare	$57.60
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Smart Auto/Commercial	$57.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$57.60
Rate for Payer: LLUH Dept of Risk Management WC	$52.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$72.00

HC LAB REF RISPERIDONE

Facility

$96.00

Service Code	CPT 80342
Hospital Charge Code	900910787
Hospital Revenue Code	301
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$76.80
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cigna of CA HMO/PPO	$76.80
Rate for Payer: Health Smart Auto/Commercial	$57.60
Rate for Payer: LLUH Dept of Risk Management WC	$52.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$72.00

HC LAB REF SALMONELLA SEROTYPING

Facility

$158.00

Service Code	CPT 87147 90
Hospital Charge Code	900911296
Hospital Revenue Code	306
Min. Negotiated Rate	$86.90
Max. Negotiated Rate	$118.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$94.80
Rate for Payer: Aetna of CA Government/Medicare	$94.80
Rate for Payer: Cash Price	$71.10
Rate for Payer: Health Smart Auto/Commercial	$94.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$94.80
Rate for Payer: LLUH Dept of Risk Management WC	$86.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$118.50

HC LAB REF SALMONELLA SEROTYPING

Facility

$158.00

Service Code	CPT 87147
Hospital Charge Code	900911296
Hospital Revenue Code	306
Min. Negotiated Rate	$86.90
Max. Negotiated Rate	$126.40
Rate for Payer: Cash Price	$71.10
Rate for Payer: Cigna of CA HMO/PPO	$126.40
Rate for Payer: Health Smart Auto/Commercial	$94.80
Rate for Payer: LLUH Dept of Risk Management WC	$86.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$118.50

HC LAB REF SALMONELLA SEROTYPING

Facility

$158.00

Service Code	CPT 87147 90
Hospital Charge Code	900911296
Hospital Revenue Code	306
Min. Negotiated Rate	$86.90
Max. Negotiated Rate	$126.40
Rate for Payer: Cash Price	$71.10
Rate for Payer: Cigna of CA HMO/PPO	$126.40
Rate for Payer: Health Smart Auto/Commercial	$94.80
Rate for Payer: LLUH Dept of Risk Management WC	$86.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$118.50

HC LAB REF SALMONELLA SEROTYPING

Facility

$158.00

Service Code	CPT 87147
Hospital Charge Code	900911296
Hospital Revenue Code	306
Min. Negotiated Rate	$86.90
Max. Negotiated Rate	$118.50
Rate for Payer: Health Smart Auto/Commercial	$94.80
Rate for Payer: Cash Price	$71.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$94.80
Rate for Payer: Aetna of CA Government/Medicare	$94.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$94.80
Rate for Payer: LLUH Dept of Risk Management WC	$86.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$118.50

HC LAB REF SCRUB TYPHUS

Facility

$142.00

Service Code	CPT 86757 90
Hospital Charge Code	900912586
Hospital Revenue Code	302
Min. Negotiated Rate	$78.10
Max. Negotiated Rate	$106.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$85.20
Rate for Payer: Aetna of CA Government/Medicare	$85.20
Rate for Payer: Cash Price	$63.90
Rate for Payer: Health Smart Auto/Commercial	$85.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$85.20
Rate for Payer: LLUH Dept of Risk Management WC	$78.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$106.50

HC LAB REF SCRUB TYPHUS

Facility

$142.00

Service Code	CPT 86757
Hospital Charge Code	900912586
Hospital Revenue Code	302
Min. Negotiated Rate	$78.10
Max. Negotiated Rate	$113.60
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna of CA HMO/PPO	$113.60
Rate for Payer: Health Smart Auto/Commercial	$85.20
Rate for Payer: LLUH Dept of Risk Management WC	$78.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$106.50

HC LAB REF SCRUB TYPHUS

Facility

$142.00

Service Code	CPT 86757 90
Hospital Charge Code	900912586
Hospital Revenue Code	302
Min. Negotiated Rate	$78.10
Max. Negotiated Rate	$113.60
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna of CA HMO/PPO	$113.60
Rate for Payer: Health Smart Auto/Commercial	$85.20
Rate for Payer: LLUH Dept of Risk Management WC	$78.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$106.50

HC LAB REF SCRUB TYPHUS

Facility

$142.00

Service Code	CPT 86757
Hospital Charge Code	900912586
Hospital Revenue Code	302
Min. Negotiated Rate	$78.10
Max. Negotiated Rate	$106.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$85.20
Rate for Payer: Aetna of CA Government/Medicare	$85.20
Rate for Payer: Cash Price	$63.90
Rate for Payer: Health Smart Auto/Commercial	$85.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$85.20
Rate for Payer: LLUH Dept of Risk Management WC	$78.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$106.50

HC LAB REF SPERM IGG AB

Facility

$98.00

Service Code	CPT 89325 90
Hospital Charge Code	900911439
Hospital Revenue Code	300
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$73.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$58.80
Rate for Payer: Aetna of CA Government/Medicare	$58.80
Rate for Payer: Cash Price	$44.10
Rate for Payer: Health Smart Auto/Commercial	$58.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$58.80
Rate for Payer: LLUH Dept of Risk Management WC	$53.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$73.50

HC LAB REF SPERM IGG AB

Facility

$98.00

Service Code	CPT 89325
Hospital Charge Code	900911439
Hospital Revenue Code	300
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$78.40
Rate for Payer: Cash Price	$44.10
Rate for Payer: Cigna of CA HMO/PPO	$78.40
Rate for Payer: Health Smart Auto/Commercial	$58.80
Rate for Payer: LLUH Dept of Risk Management WC	$53.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$73.50

HC LAB REF SPERM IGG AB

Facility

$98.00

Service Code	CPT 89325
Hospital Charge Code	900911439
Hospital Revenue Code	300
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$73.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$58.80
Rate for Payer: Aetna of CA Government/Medicare	$58.80
Rate for Payer: Cash Price	$44.10
Rate for Payer: Health Smart Auto/Commercial	$58.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$58.80
Rate for Payer: LLUH Dept of Risk Management WC	$53.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$73.50

HC LAB REF SPERM IGG AB

Facility

$98.00

Service Code	CPT 89325 90
Hospital Charge Code	900911439
Hospital Revenue Code	300
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$78.40
Rate for Payer: Cash Price	$44.10
Rate for Payer: Cigna of CA HMO/PPO	$78.40
Rate for Payer: Health Smart Auto/Commercial	$58.80
Rate for Payer: LLUH Dept of Risk Management WC	$53.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$73.50

HC LAB REF ST LOUIS ENCEPH AB IGM

Facility

$21.00

Service Code	CPT 86653 90
Hospital Charge Code	900912652
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 ST LOUIS ENCEPH AB IGM

Facility

$21.00

Service Code	CPT 86653
Hospital Charge Code	900912652
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 ST LOUIS ENCEPH AB IGM

Facility

$21.00

Service Code	CPT 86653
Hospital Charge Code	900912652
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 ST LOUIS ENCEPH AB IGM

Facility

$21.00

Service Code	CPT 86653 90
Hospital Charge Code	900912652
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 STREPTOMYCIN LEVEL

Facility

$135.00

Service Code	CPT 80299
Hospital Charge Code	900911595
Hospital Revenue Code	301
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$101.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$81.00
Rate for Payer: Aetna of CA Government/Medicare	$81.00
Rate for Payer: Cash Price	$60.75
Rate for Payer: Health Smart Auto/Commercial	$81.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$81.00
Rate for Payer: LLUH Dept of Risk Management WC	$74.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$101.25

HC LAB REF STREPTOMYCIN LEVEL

Facility

$135.00

Service Code	CPT 80299 90
Hospital Charge Code	900911595
Hospital Revenue Code	301
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$101.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$81.00
Rate for Payer: Aetna of CA Government/Medicare	$81.00
Rate for Payer: Cash Price	$60.75
Rate for Payer: Health Smart Auto/Commercial	$81.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$81.00
Rate for Payer: LLUH Dept of Risk Management WC	$74.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$101.25

HC LAB REF STREPTOMYCIN LEVEL

Facility

$135.00

Service Code	CPT 80299 90
Hospital Charge Code	900911595
Hospital Revenue Code	301
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$108.00
Rate for Payer: Cash Price	$60.75
Rate for Payer: Cigna of CA HMO/PPO	$108.00
Rate for Payer: Health Smart Auto/Commercial	$81.00
Rate for Payer: LLUH Dept of Risk Management WC	$74.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$101.25

HC LAB REF STREPTOMYCIN LEVEL

Facility

$135.00

Service Code	CPT 80299
Hospital Charge Code	900911595
Hospital Revenue Code	301
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$108.00
Rate for Payer: Cash Price	$60.75
Rate for Payer: Cigna of CA HMO/PPO	$108.00
Rate for Payer: Health Smart Auto/Commercial	$81.00
Rate for Payer: LLUH Dept of Risk Management WC	$74.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$101.25

HC LAB REF STRIATIONAL ABS

Facility

$21.00

Service Code	CPT 83520
Hospital Charge Code	900912585
Hospital Revenue Code	301
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 STRIATIONAL ABS

Facility

$21.00

Service Code	CPT 83520 90
Hospital Charge Code	900912585
Hospital Revenue Code	301
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 STRIATIONAL ABS

Facility

$21.00

Service Code	CPT 83520
Hospital Charge Code	900912585
Hospital Revenue Code	301
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