Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC B-CELL LYMPH FISH DNA PROBE SO

Facility

$86.00

Service Code	CPT 88271 90,TC
Hospital Charge Code	900914114
Hospital Revenue Code	301
Min. Negotiated Rate	$47.30
Max. Negotiated Rate	$68.80
Rate for Payer: Cash Price	$38.70
Rate for Payer: Cigna of CA HMO/PPO	$68.80
Rate for Payer: Health Smart Auto/Commercial	$51.60
Rate for Payer: LLUH Dept of Risk Management WC	$47.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$64.50

HC B-CELL LYMPH FISH DNA PROBE SO

Facility

$86.00

Service Code	CPT 88271 90,TC
Hospital Charge Code	900914114
Hospital Revenue Code	301
Min. Negotiated Rate	$47.30
Max. Negotiated Rate	$64.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$51.60
Rate for Payer: Aetna of CA Government/Medicare	$51.60
Rate for Payer: Cash Price	$38.70
Rate for Payer: Health Smart Auto/Commercial	$51.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$51.60
Rate for Payer: LLUH Dept of Risk Management WC	$47.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$64.50

HC B-CELL LYMPH FISH DNA PROBE SO

Facility

$86.00

Service Code	CPT 88271
Hospital Charge Code	900914114
Hospital Revenue Code	309
Min. Negotiated Rate	$47.30
Max. Negotiated Rate	$68.80
Rate for Payer: Cash Price	$38.70
Rate for Payer: Cigna of CA HMO/PPO	$68.80
Rate for Payer: Health Smart Auto/Commercial	$51.60
Rate for Payer: LLUH Dept of Risk Management WC	$47.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$64.50

HC B-CELL LYMPH FISH DNA PROBE SO

Facility

$86.00

Service Code	CPT 88271
Hospital Charge Code	900914114
Hospital Revenue Code	309
Min. Negotiated Rate	$47.30
Max. Negotiated Rate	$64.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$51.60
Rate for Payer: Aetna of CA Government/Medicare	$51.60
Rate for Payer: Cash Price	$38.70
Rate for Payer: Health Smart Auto/Commercial	$51.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$51.60
Rate for Payer: LLUH Dept of Risk Management WC	$47.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$64.50

HC B-CELL LYMPH FISH INTRPHAS IN

Facility

$162.00

Service Code	CPT 88275
Hospital Charge Code	900914115
Hospital Revenue Code	309
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$129.60
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cigna of CA HMO/PPO	$129.60
Rate for Payer: Health Smart Auto/Commercial	$97.20
Rate for Payer: LLUH Dept of Risk Management WC	$89.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$121.50

HC B-CELL LYMPH FISH INTRPHAS IN

Facility

$162.00

Service Code	CPT 88275 90,TC
Hospital Charge Code	900914115
Hospital Revenue Code	301
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$129.60
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cigna of CA HMO/PPO	$129.60
Rate for Payer: Health Smart Auto/Commercial	$97.20
Rate for Payer: LLUH Dept of Risk Management WC	$89.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$121.50

HC B-CELL LYMPH FISH INTRPHAS IN

Facility

$162.00

Service Code	CPT 88275
Hospital Charge Code	900914115
Hospital Revenue Code	309
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$97.20
Rate for Payer: Aetna of CA Government/Medicare	$97.20
Rate for Payer: Cash Price	$72.90
Rate for Payer: Health Smart Auto/Commercial	$97.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$97.20
Rate for Payer: LLUH Dept of Risk Management WC	$89.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$121.50

HC B-CELL LYMPH FISH INTRPHAS IN

Facility

$162.00

Service Code	CPT 88275 90,TC
Hospital Charge Code	900914115
Hospital Revenue Code	301
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$97.20
Rate for Payer: Aetna of CA Government/Medicare	$97.20
Rate for Payer: Cash Price	$72.90
Rate for Payer: Health Smart Auto/Commercial	$97.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$97.20
Rate for Payer: LLUH Dept of Risk Management WC	$89.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$121.50

HC BENZODIAZPINES CONF

Facility

$271.00

Service Code	CPT G0480 90
Hospital Charge Code	900910515
Hospital Revenue Code	301
Min. Negotiated Rate	$149.05
Max. Negotiated Rate	$216.80
Rate for Payer: Cash Price	$121.95
Rate for Payer: Cigna of CA HMO/PPO	$216.80
Rate for Payer: Health Smart Auto/Commercial	$162.60
Rate for Payer: LLUH Dept of Risk Management WC	$149.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$203.25

HC BENZODIAZPINES CONF

Facility

$271.00

Service Code	CPT 80346
Hospital Charge Code	900910515
Hospital Revenue Code	301
Min. Negotiated Rate	$149.05
Max. Negotiated Rate	$216.80
Rate for Payer: Cash Price	$121.95
Rate for Payer: Cigna of CA HMO/PPO	$216.80
Rate for Payer: Health Smart Auto/Commercial	$162.60
Rate for Payer: LLUH Dept of Risk Management WC	$149.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$203.25

HC BENZODIAZPINES CONF

Facility

$225.00

Service Code	CPT G0480
Hospital Charge Code	900910515
Hospital Revenue Code	301
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$168.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$135.00
Rate for Payer: Aetna of CA Government/Medicare	$135.00
Rate for Payer: Cash Price	$101.25
Rate for Payer: Health Smart Auto/Commercial	$135.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$135.00
Rate for Payer: LLUH Dept of Risk Management WC	$123.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$168.75

HC BENZODIAZPINES CONF

Facility

$225.00

Service Code	CPT 80346
Hospital Charge Code	900910515
Hospital Revenue Code	301
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$168.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$135.00
Rate for Payer: Aetna of CA Government/Medicare	$135.00
Rate for Payer: Cash Price	$101.25
Rate for Payer: Health Smart Auto/Commercial	$135.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$135.00
Rate for Payer: LLUH Dept of Risk Management WC	$123.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$168.75

HC BENZODIAZPINES CONF

Facility

$271.00

Service Code	CPT G0480
Hospital Charge Code	900910515
Hospital Revenue Code	301
Min. Negotiated Rate	$149.05
Max. Negotiated Rate	$216.80
Rate for Payer: Cash Price	$121.95
Rate for Payer: Cigna of CA HMO/PPO	$216.80
Rate for Payer: Health Smart Auto/Commercial	$162.60
Rate for Payer: LLUH Dept of Risk Management WC	$149.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$203.25

HC BETA HCG POC

Facility

$17.00

Service Code	CPT 84703
Hospital Charge Code	900912138
Hospital Revenue Code	306
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$12.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.20
Rate for Payer: Aetna of CA Government/Medicare	$10.20
Rate for Payer: Cash Price	$7.65
Rate for Payer: Health Smart Auto/Commercial	$10.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.20
Rate for Payer: LLUH Dept of Risk Management WC	$9.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.75

HC BETA HCG POC

Facility

$170.00

Service Code	CPT 84703
Hospital Charge Code	900912138
Hospital Revenue Code	306
Min. Negotiated Rate	$93.50
Max. Negotiated Rate	$136.00
Rate for Payer: Cash Price	$76.50
Rate for Payer: Cigna of CA HMO/PPO	$136.00
Rate for Payer: Health Smart Auto/Commercial	$102.00
Rate for Payer: LLUH Dept of Risk Management WC	$93.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$127.50

HC BETA HCG, QUAL

Facility

$170.00

Service Code	CPT 84703
Hospital Charge Code	900910840
Hospital Revenue Code	301
Min. Negotiated Rate	$93.50
Max. Negotiated Rate	$136.00
Rate for Payer: Cash Price	$76.50
Rate for Payer: Cigna of CA HMO/PPO	$136.00
Rate for Payer: Health Smart Auto/Commercial	$102.00
Rate for Payer: LLUH Dept of Risk Management WC	$93.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$127.50

HC BETA HCG, QUAL

Facility

$28.00

Service Code	CPT 84703
Hospital Charge Code	900910840
Hospital Revenue Code	301
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.80
Rate for Payer: Aetna of CA Government/Medicare	$16.80
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Smart Auto/Commercial	$16.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.80
Rate for Payer: LLUH Dept of Risk Management WC	$15.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21.00

HC BETA HCG, QUANT

Facility

$406.00

Service Code	CPT 84702
Hospital Charge Code	900910814
Hospital Revenue Code	301
Min. Negotiated Rate	$223.30
Max. Negotiated Rate	$324.80
Rate for Payer: Cash Price	$182.70
Rate for Payer: Cigna of CA HMO/PPO	$324.80
Rate for Payer: Health Smart Auto/Commercial	$243.60
Rate for Payer: LLUH Dept of Risk Management WC	$223.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$304.50

HC BETA HCG, QUANT

Facility

$57.00

Service Code	CPT 84702
Hospital Charge Code	900910814
Hospital Revenue Code	301
Min. Negotiated Rate	$31.35
Max. Negotiated Rate	$42.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$34.20
Rate for Payer: Aetna of CA Government/Medicare	$34.20
Rate for Payer: Cash Price	$25.65
Rate for Payer: Health Smart Auto/Commercial	$34.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$34.20
Rate for Payer: LLUH Dept of Risk Management WC	$31.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$42.75

HC BETA-HYDROXYBUTYRATE

Facility

$235.00

Service Code	CPT 82010
Hospital Charge Code	900910356
Hospital Revenue Code	301
Min. Negotiated Rate	$129.25
Max. Negotiated Rate	$188.00
Rate for Payer: Cash Price	$105.75
Rate for Payer: Cigna of CA HMO/PPO	$188.00
Rate for Payer: Health Smart Auto/Commercial	$141.00
Rate for Payer: LLUH Dept of Risk Management WC	$129.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$176.25

HC BETA-HYDROXYBUTYRATE

Facility

$31.00

Service Code	CPT 82010
Hospital Charge Code	900910356
Hospital Revenue Code	301
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.60
Rate for Payer: Aetna of CA Government/Medicare	$18.60
Rate for Payer: Cash Price	$13.95
Rate for Payer: Health Smart Auto/Commercial	$18.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.60
Rate for Payer: LLUH Dept of Risk Management WC	$17.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$23.25

HC BETA STREP RAPID TEST

Facility

$141.00

Service Code	CPT 87430
Hospital Charge Code	900911635
Hospital Revenue Code	306
Min. Negotiated Rate	$77.55
Max. Negotiated Rate	$112.80
Rate for Payer: Cash Price	$63.45
Rate for Payer: Cigna of CA HMO/PPO	$112.80
Rate for Payer: Health Smart Auto/Commercial	$84.60
Rate for Payer: LLUH Dept of Risk Management WC	$77.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$105.75

HC BETA STREP RAPID TEST

Facility

$36.00

Service Code	CPT 87430
Hospital Charge Code	900911635
Hospital Revenue Code	306
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.60
Rate for Payer: Aetna of CA Government/Medicare	$21.60
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.00

HC BILIRUBIN DIRECT

Facility

$15.00

Service Code	CPT 82248
Hospital Charge Code	900910504
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 BILIRUBIN DIRECT

Facility

$89.00

Service Code	CPT 82248
Hospital Charge Code	900910504
Hospital Revenue Code	301
Min. Negotiated Rate	$48.95
Max. Negotiated Rate	$71.20
Rate for Payer: Cash Price	$40.05
Rate for Payer: Cigna of CA HMO/PPO	$71.20
Rate for Payer: Health Smart Auto/Commercial	$53.40
Rate for Payer: LLUH Dept of Risk Management WC	$48.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$66.75

Know your out-of-pocket cost for care.

All Charges