Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC CHROM ADDL SPEC BANDING

Facility

$93.00

Service Code	CPT 88283
Hospital Charge Code	900918012
Hospital Revenue Code	310
Min. Negotiated Rate	$51.15
Max. Negotiated Rate	$74.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$55.80
Rate for Payer: Aetna of CA Government/Medicare	$55.80
Rate for Payer: Cash Price	$41.85
Rate for Payer: Cash Price	$41.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$74.40
Rate for Payer: Health Smart Auto/Commercial	$55.80
Rate for Payer: Intervalley Health Plan Commercial	$68.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$55.80
Rate for Payer: LLUH Dept of Risk Management WC	$51.15
Rate for Payer: Multiplan Commercial	$69.75

HC CHROM AMNIO 15 CELLS 1 KARYO

Facility

$339.00

Service Code	CPT 88267
Hospital Charge Code	900918015
Hospital Revenue Code	310
Min. Negotiated Rate	$186.45
Max. Negotiated Rate	$271.20
Rate for Payer: Cash Price	$152.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$271.20
Rate for Payer: Health Smart Auto/Commercial	$203.40
Rate for Payer: LLUH Dept of Risk Management WC	$186.45
Rate for Payer: Multiplan Commercial	$254.25

HC CHROM AMNIO 15 CELLS 1 KARYO

Facility

$246.00

Service Code	CPT 88267
Hospital Charge Code	900918015
Hospital Revenue Code	310
Min. Negotiated Rate	$135.30
Max. Negotiated Rate	$196.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$147.60
Rate for Payer: Aetna of CA Government/Medicare	$147.60
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$196.80
Rate for Payer: Health Smart Auto/Commercial	$147.60
Rate for Payer: Intervalley Health Plan Commercial	$188.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$147.60
Rate for Payer: LLUH Dept of Risk Management WC	$135.30
Rate for Payer: Multiplan Commercial	$184.50

HC CHROM AMNIO 6-12 COLN 1 KARYO

Facility

$230.00

Service Code	CPT 88269
Hospital Charge Code	900918014
Hospital Revenue Code	310
Min. Negotiated Rate	$126.50
Max. Negotiated Rate	$184.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$138.00
Rate for Payer: Aetna of CA Government/Medicare	$138.00
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cash Price	$103.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$184.00
Rate for Payer: Health Smart Auto/Commercial	$138.00
Rate for Payer: Intervalley Health Plan Commercial	$173.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$138.00
Rate for Payer: LLUH Dept of Risk Management WC	$126.50
Rate for Payer: Multiplan Commercial	$172.50

HC CHROM AMNIO 6-12 COLN 1 KARYO

Facility

$321.00

Service Code	CPT 88269
Hospital Charge Code	900918014
Hospital Revenue Code	310
Min. Negotiated Rate	$176.55
Max. Negotiated Rate	$256.80
Rate for Payer: Cash Price	$144.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$256.80
Rate for Payer: Health Smart Auto/Commercial	$192.60
Rate for Payer: LLUH Dept of Risk Management WC	$176.55
Rate for Payer: Multiplan Commercial	$240.75

HC CHROM ANLZ 15-20 CELLS 2 KARYO

Facility

$564.00

Service Code	CPT 88262
Hospital Charge Code	900918020
Hospital Revenue Code	310
Min. Negotiated Rate	$310.20
Max. Negotiated Rate	$451.20
Rate for Payer: Cash Price	$253.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$451.20
Rate for Payer: Health Smart Auto/Commercial	$338.40
Rate for Payer: LLUH Dept of Risk Management WC	$310.20
Rate for Payer: Multiplan Commercial	$423.00

HC CHROM ANLZ 15-20 CELLS 2 KARYO

Facility

$400.00

Service Code	CPT 88262
Hospital Charge Code	900918020
Hospital Revenue Code	310
Min. Negotiated Rate	$125.49
Max. Negotiated Rate	$320.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$240.00
Rate for Payer: Aetna of CA Government/Medicare	$240.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$320.00
Rate for Payer: Health Smart Auto/Commercial	$240.00
Rate for Payer: Intervalley Health Plan Commercial	$125.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$240.00
Rate for Payer: LLUH Dept of Risk Management WC	$220.00
Rate for Payer: Multiplan Commercial	$300.00

HC CHROM ANLZ 20-25 CELLS

Facility

$400.00

Service Code	CPT 88264
Hospital Charge Code	900918016
Hospital Revenue Code	310
Min. Negotiated Rate	$144.61
Max. Negotiated Rate	$320.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$240.00
Rate for Payer: Aetna of CA Government/Medicare	$240.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$320.00
Rate for Payer: Health Smart Auto/Commercial	$240.00
Rate for Payer: Intervalley Health Plan Commercial	$144.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$240.00
Rate for Payer: LLUH Dept of Risk Management WC	$220.00
Rate for Payer: Multiplan Commercial	$300.00

HC CHROM ANLZ 20-25 CELLS

Facility

$564.00

Service Code	CPT 88264
Hospital Charge Code	900918016
Hospital Revenue Code	310
Min. Negotiated Rate	$310.20
Max. Negotiated Rate	$451.20
Rate for Payer: Cash Price	$253.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$451.20
Rate for Payer: Health Smart Auto/Commercial	$338.40
Rate for Payer: LLUH Dept of Risk Management WC	$310.20
Rate for Payer: Multiplan Commercial	$423.00

HC CHROM ANLZ 45 CEL MSAIC 2 KRYO

Facility

$208.00

Service Code	CPT 88263
Hospital Charge Code	900918017
Hospital Revenue Code	310
Min. Negotiated Rate	$114.40
Max. Negotiated Rate	$166.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$124.80
Rate for Payer: Aetna of CA Government/Medicare	$124.80
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$166.40
Rate for Payer: Health Smart Auto/Commercial	$124.80
Rate for Payer: Intervalley Health Plan Commercial	$150.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$124.80
Rate for Payer: LLUH Dept of Risk Management WC	$114.40
Rate for Payer: Multiplan Commercial	$156.00

HC CHROM ANLZ 45 CEL MSAIC 2 KRYO

Facility

$291.00

Service Code	CPT 88263
Hospital Charge Code	900918017
Hospital Revenue Code	310
Min. Negotiated Rate	$160.05
Max. Negotiated Rate	$232.80
Rate for Payer: Cash Price	$130.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$232.80
Rate for Payer: Health Smart Auto/Commercial	$174.60
Rate for Payer: LLUH Dept of Risk Management WC	$160.05
Rate for Payer: Multiplan Commercial	$218.25

HC CHROM ANLZ 5 CELLS 1 KARYO

Facility

$403.00

Service Code	CPT 88261
Hospital Charge Code	900918019
Hospital Revenue Code	310
Min. Negotiated Rate	$221.65
Max. Negotiated Rate	$322.40
Rate for Payer: Cash Price	$181.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$322.40
Rate for Payer: Health Smart Auto/Commercial	$241.80
Rate for Payer: LLUH Dept of Risk Management WC	$221.65
Rate for Payer: Multiplan Commercial	$302.25

HC CHROM ANLZ 5 CELLS 1 KARYO

Facility

$291.00

Service Code	CPT 88261
Hospital Charge Code	900918019
Hospital Revenue Code	310
Min. Negotiated Rate	$160.05
Max. Negotiated Rate	$264.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$174.60
Rate for Payer: Aetna of CA Government/Medicare	$174.60
Rate for Payer: Cash Price	$130.95
Rate for Payer: Cash Price	$130.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$232.80
Rate for Payer: Health Smart Auto/Commercial	$174.60
Rate for Payer: Intervalley Health Plan Commercial	$264.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$174.60
Rate for Payer: LLUH Dept of Risk Management WC	$160.05
Rate for Payer: Multiplan Commercial	$218.25

HC CHROM ANLZ ADDL KARYO

Facility

$42.00

Service Code	CPT 88280
Hospital Charge Code	900918018
Hospital Revenue Code	310
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$33.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$25.20
Rate for Payer: Aetna of CA Government/Medicare	$25.20
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$33.60
Rate for Payer: Health Smart Auto/Commercial	$25.20
Rate for Payer: Intervalley Health Plan Commercial	$33.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$25.20
Rate for Payer: LLUH Dept of Risk Management WC	$23.10
Rate for Payer: Multiplan Commercial	$31.50

HC CHROM ANLZ ADDL KARYO

Facility

$57.00

Service Code	CPT 88280
Hospital Charge Code	900918018
Hospital Revenue Code	310
Min. Negotiated Rate	$31.35
Max. Negotiated Rate	$45.60
Rate for Payer: Cash Price	$25.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$45.60
Rate for Payer: Health Smart Auto/Commercial	$34.20
Rate for Payer: LLUH Dept of Risk Management WC	$31.35
Rate for Payer: Multiplan Commercial	$42.75

HC CIPROFLOXACIN E TEST

Facility

$85.00

Service Code	CPT 87181
Hospital Charge Code	900912443
Hospital Revenue Code	306
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$68.00
Rate for Payer: Cash Price	$38.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$68.00
Rate for Payer: Health Smart Auto/Commercial	$51.00
Rate for Payer: LLUH Dept of Risk Management WC	$46.75
Rate for Payer: Multiplan Commercial	$63.75

HC CIPROFLOXACIN E TEST

Facility

$18.00

Service Code	CPT 87181
Hospital Charge Code	900912443
Hospital Revenue Code	306
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.80
Rate for Payer: Aetna of CA Government/Medicare	$10.80
Rate for Payer: Cash Price	$8.10
Rate for Payer: Cash Price	$8.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.40
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: Intervalley Health Plan Commercial	$4.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.80
Rate for Payer: LLUH Dept of Risk Management WC	$9.90
Rate for Payer: Multiplan Commercial	$13.50

HC CIRC ANTICOAG SCRN

Facility

$69.00

Service Code	CPT 85732
Hospital Charge Code	900910015
Hospital Revenue Code	305
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$55.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$41.40
Rate for Payer: Aetna of CA Government/Medicare	$41.40
Rate for Payer: Cash Price	$31.05
Rate for Payer: Cash Price	$31.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$55.20
Rate for Payer: Health Smart Auto/Commercial	$41.40
Rate for Payer: Intervalley Health Plan Commercial	$6.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$41.40
Rate for Payer: LLUH Dept of Risk Management WC	$37.95
Rate for Payer: Multiplan Commercial	$51.75

HC CIRC ANTICOAG SCRN

Facility

$236.00

Service Code	CPT 85732
Hospital Charge Code	900910015
Hospital Revenue Code	305
Min. Negotiated Rate	$129.80
Max. Negotiated Rate	$188.80
Rate for Payer: Cash Price	$106.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$188.80
Rate for Payer: Health Smart Auto/Commercial	$141.60
Rate for Payer: LLUH Dept of Risk Management WC	$129.80
Rate for Payer: Multiplan Commercial	$177.00

HC CITRULLINATED PEPTIDE AB

Facility

$124.00

Service Code	CPT 86200
Hospital Charge Code	900913554
Hospital Revenue Code	302
Min. Negotiated Rate	$68.20
Max. Negotiated Rate	$99.20
Rate for Payer: Cash Price	$55.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$99.20
Rate for Payer: Health Smart Auto/Commercial	$74.40
Rate for Payer: LLUH Dept of Risk Management WC	$68.20
Rate for Payer: Multiplan Commercial	$93.00

HC CITRULLINATED PEPTIDE AB

Facility

$68.00

Service Code	CPT 86200
Hospital Charge Code	900913554
Hospital Revenue Code	302
Min. Negotiated Rate	$12.95
Max. Negotiated Rate	$54.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$40.80
Rate for Payer: Aetna of CA Government/Medicare	$40.80
Rate for Payer: Cash Price	$30.60
Rate for Payer: Cash Price	$30.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$54.40
Rate for Payer: Health Smart Auto/Commercial	$40.80
Rate for Payer: Intervalley Health Plan Commercial	$12.95
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$40.80
Rate for Payer: LLUH Dept of Risk Management WC	$37.40
Rate for Payer: Multiplan Commercial	$51.00

HC CK-MB

Facility

$84.00

Service Code	CPT 82553
Hospital Charge Code	900910805
Hospital Revenue Code	301
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$67.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$50.40
Rate for Payer: Aetna of CA Government/Medicare	$50.40
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cash Price	$37.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$67.20
Rate for Payer: Health Smart Auto/Commercial	$50.40
Rate for Payer: Intervalley Health Plan Commercial	$11.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$50.40
Rate for Payer: LLUH Dept of Risk Management WC	$46.20
Rate for Payer: Multiplan Commercial	$63.00

HC CK-MB

Facility

$298.00

Service Code	CPT 82553
Hospital Charge Code	900910805
Hospital Revenue Code	301
Min. Negotiated Rate	$163.90
Max. Negotiated Rate	$238.40
Rate for Payer: Cash Price	$134.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$238.40
Rate for Payer: Health Smart Auto/Commercial	$178.80
Rate for Payer: LLUH Dept of Risk Management WC	$163.90
Rate for Payer: Multiplan Commercial	$223.50

HC CLOSTRIDIUM DIFFICILE GDH

Facility

$83.00

Service Code	CPT 87449
Hospital Charge Code	900913622
Hospital Revenue Code	306
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$66.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$49.80
Rate for Payer: Aetna of CA Government/Medicare	$49.80
Rate for Payer: Cash Price	$37.35
Rate for Payer: Cash Price	$37.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$66.40
Rate for Payer: Health Smart Auto/Commercial	$49.80
Rate for Payer: Intervalley Health Plan Commercial	$11.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$49.80
Rate for Payer: LLUH Dept of Risk Management WC	$45.65
Rate for Payer: Multiplan Commercial	$62.25

HC CLOSTRIDIUM DIFFICILE GDH

Facility

$96.00

Service Code	CPT 87449
Hospital Charge Code	900913622
Hospital Revenue Code	306
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$76.80
Rate for Payer: Cash Price	$43.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$72.00

Know your out-of-pocket cost for care.

All Charges