Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC FA STAIN INFLUENZA A

Facility

$332.00

Service Code	CPT 87276
Hospital Charge Code	900911781
Hospital Revenue Code	306
Min. Negotiated Rate	$182.60
Max. Negotiated Rate	$265.60
Rate for Payer: Cash Price	$149.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$265.60
Rate for Payer: Health Smart Auto/Commercial	$199.20
Rate for Payer: LLUH Dept of Risk Management WC	$182.60
Rate for Payer: Multiplan Commercial	$249.00

HC FA STAIN INFLUENZA A

Facility

$38.00

Service Code	CPT 87276
Hospital Charge Code	900911781
Hospital Revenue Code	306
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$30.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.80
Rate for Payer: Aetna of CA Government/Medicare	$22.80
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cash Price	$17.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.40
Rate for Payer: Health Smart Auto/Commercial	$22.80
Rate for Payer: Intervalley Health Plan Commercial	$16.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.80
Rate for Payer: LLUH Dept of Risk Management WC	$20.90
Rate for Payer: Multiplan Commercial	$28.50

HC FA STAIN INFLUENZA B

Facility

$38.00

Service Code	CPT 87275
Hospital Charge Code	900911782
Hospital Revenue Code	306
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$30.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.80
Rate for Payer: Aetna of CA Government/Medicare	$22.80
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cash Price	$17.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.40
Rate for Payer: Health Smart Auto/Commercial	$22.80
Rate for Payer: Intervalley Health Plan Commercial	$12.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.80
Rate for Payer: LLUH Dept of Risk Management WC	$20.90
Rate for Payer: Multiplan Commercial	$28.50

HC FA STAIN INFLUENZA B

Facility

$332.00

Service Code	CPT 87275
Hospital Charge Code	900911782
Hospital Revenue Code	306
Min. Negotiated Rate	$182.60
Max. Negotiated Rate	$265.60
Rate for Payer: Cash Price	$149.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$265.60
Rate for Payer: Health Smart Auto/Commercial	$199.20
Rate for Payer: LLUH Dept of Risk Management WC	$182.60
Rate for Payer: Multiplan Commercial	$249.00

HC FA STAIN LEGIONELLA

Facility

$332.00

Service Code	CPT 87278
Hospital Charge Code	900911733
Hospital Revenue Code	306
Min. Negotiated Rate	$182.60
Max. Negotiated Rate	$265.60
Rate for Payer: Cash Price	$149.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$265.60
Rate for Payer: Health Smart Auto/Commercial	$199.20
Rate for Payer: LLUH Dept of Risk Management WC	$182.60
Rate for Payer: Multiplan Commercial	$249.00

HC FA STAIN LEGIONELLA

Facility

$38.00

Service Code	CPT 87278
Hospital Charge Code	900911733
Hospital Revenue Code	306
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$30.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.80
Rate for Payer: Aetna of CA Government/Medicare	$22.80
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cash Price	$17.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.40
Rate for Payer: Health Smart Auto/Commercial	$22.80
Rate for Payer: Intervalley Health Plan Commercial	$15.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.80
Rate for Payer: LLUH Dept of Risk Management WC	$20.90
Rate for Payer: Multiplan Commercial	$28.50

HC FA STAIN PARAINFLUENZA

Facility

$38.00

Service Code	CPT 87279
Hospital Charge Code	900911783
Hospital Revenue Code	306
Min. Negotiated Rate	$16.43
Max. Negotiated Rate	$30.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.80
Rate for Payer: Aetna of CA Government/Medicare	$22.80
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cash Price	$17.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.40
Rate for Payer: Health Smart Auto/Commercial	$22.80
Rate for Payer: Intervalley Health Plan Commercial	$16.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.80
Rate for Payer: LLUH Dept of Risk Management WC	$20.90
Rate for Payer: Multiplan Commercial	$28.50

HC FA STAIN PARAINFLUENZA

Facility

$332.00

Service Code	CPT 87279
Hospital Charge Code	900911783
Hospital Revenue Code	306
Min. Negotiated Rate	$182.60
Max. Negotiated Rate	$265.60
Rate for Payer: Cash Price	$149.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$265.60
Rate for Payer: Health Smart Auto/Commercial	$199.20
Rate for Payer: LLUH Dept of Risk Management WC	$182.60
Rate for Payer: Multiplan Commercial	$249.00

HC FERRITIN

Facility

$132.47

Service Code	CPT 82728
Hospital Charge Code	900910819
Hospital Revenue Code	301
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$105.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$79.48
Rate for Payer: Aetna of CA Government/Medicare	$79.48
Rate for Payer: Cash Price	$59.61
Rate for Payer: Cash Price	$59.61
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$105.98
Rate for Payer: Health Smart Auto/Commercial	$79.48
Rate for Payer: Intervalley Health Plan Commercial	$13.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$79.48
Rate for Payer: LLUH Dept of Risk Management WC	$72.86
Rate for Payer: Multiplan Commercial	$99.35

HC FERRITIN

Facility

$270.00

Service Code	CPT 82728
Hospital Charge Code	900910819
Hospital Revenue Code	301
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$216.00
Rate for Payer: Cash Price	$121.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$216.00
Rate for Payer: Health Smart Auto/Commercial	$162.00
Rate for Payer: LLUH Dept of Risk Management WC	$148.50
Rate for Payer: Multiplan Commercial	$202.50

HC FETAL FIBRONECTIN

Facility

$1,778.00

Service Code	CPT 82731
Hospital Charge Code	900912319
Hospital Revenue Code	304
Min. Negotiated Rate	$977.90
Max. Negotiated Rate	$1,422.40
Rate for Payer: Cash Price	$800.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,422.40
Rate for Payer: Health Smart Auto/Commercial	$1,066.80
Rate for Payer: LLUH Dept of Risk Management WC	$977.90
Rate for Payer: Multiplan Commercial	$1,333.50

HC FETAL FIBRONECTIN

Facility

$205.00

Service Code	CPT 82731
Hospital Charge Code	900912319
Hospital Revenue Code	304
Min. Negotiated Rate	$64.41
Max. Negotiated Rate	$164.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$123.00
Rate for Payer: Aetna of CA Government/Medicare	$123.00
Rate for Payer: Cash Price	$92.25
Rate for Payer: Cash Price	$92.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$164.00
Rate for Payer: Health Smart Auto/Commercial	$123.00
Rate for Payer: Intervalley Health Plan Commercial	$64.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$123.00
Rate for Payer: LLUH Dept of Risk Management WC	$112.75
Rate for Payer: Multiplan Commercial	$153.75

HC FETAL LUNG MATURITY (FLM)

Facility

$538.00

Service Code	CPT 83663
Hospital Charge Code	900910962
Hospital Revenue Code	301
Min. Negotiated Rate	$18.91
Max. Negotiated Rate	$430.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$322.80
Rate for Payer: Aetna of CA Government/Medicare	$322.80
Rate for Payer: Cash Price	$242.10
Rate for Payer: Cash Price	$242.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$430.40
Rate for Payer: Health Smart Auto/Commercial	$322.80
Rate for Payer: Intervalley Health Plan Commercial	$18.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$322.80
Rate for Payer: LLUH Dept of Risk Management WC	$295.90
Rate for Payer: Multiplan Commercial	$403.50

HC FETAL LUNG MATURITY (FLM)

Facility

$538.00

Service Code	CPT 83663
Hospital Charge Code	900910962
Hospital Revenue Code	301
Min. Negotiated Rate	$295.90
Max. Negotiated Rate	$430.40
Rate for Payer: Cash Price	$242.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$430.40
Rate for Payer: Health Smart Auto/Commercial	$322.80
Rate for Payer: LLUH Dept of Risk Management WC	$295.90
Rate for Payer: Multiplan Commercial	$403.50

HC FIBRIN DEGRAD SPLIT PRODUCTS

Facility

$37.00

Service Code	CPT 85362
Hospital Charge Code	900910069
Hospital Revenue Code	305
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$29.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.20
Rate for Payer: Aetna of CA Government/Medicare	$22.20
Rate for Payer: Cash Price	$16.65
Rate for Payer: Cash Price	$16.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$29.60
Rate for Payer: Health Smart Auto/Commercial	$22.20
Rate for Payer: Intervalley Health Plan Commercial	$6.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.20
Rate for Payer: LLUH Dept of Risk Management WC	$20.35
Rate for Payer: Multiplan Commercial	$27.75

HC FIBRIN DEGRAD SPLIT PRODUCTS

Facility

$262.00

Service Code	CPT 85362
Hospital Charge Code	900910069
Hospital Revenue Code	305
Min. Negotiated Rate	$144.10
Max. Negotiated Rate	$209.60
Rate for Payer: Cash Price	$117.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$209.60
Rate for Payer: Health Smart Auto/Commercial	$157.20
Rate for Payer: LLUH Dept of Risk Management WC	$144.10
Rate for Payer: Multiplan Commercial	$196.50

HC FIBRINOGEN ASSAY

Facility

$299.00

Service Code	CPT 85384
Hospital Charge Code	900910013
Hospital Revenue Code	305
Min. Negotiated Rate	$164.45
Max. Negotiated Rate	$239.20
Rate for Payer: Cash Price	$134.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$239.20
Rate for Payer: Health Smart Auto/Commercial	$179.40
Rate for Payer: LLUH Dept of Risk Management WC	$164.45
Rate for Payer: Multiplan Commercial	$224.25

HC FIBRINOGEN ASSAY

Facility

$84.00

Service Code	CPT 85384
Hospital Charge Code	900910013
Hospital Revenue Code	305
Min. Negotiated Rate	$9.72
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	$9.72
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 FINGERS MIN 2 VIEWS

Facility

$736.00

Service Code	CPT 73140
Hospital Charge Code	909001521
Hospital Revenue Code	320
Min. Negotiated Rate	$404.80
Max. Negotiated Rate	$588.80
Rate for Payer: Cash Price	$331.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$588.80
Rate for Payer: Health Smart Auto/Commercial	$441.60
Rate for Payer: LLUH Dept of Risk Management WC	$404.80
Rate for Payer: Multiplan Commercial	$552.00

HC FINGERS MIN 2 VIEWS

Facility

$736.00

Service Code	CPT 73140
Hospital Charge Code	909001521
Hospital Revenue Code	320
Min. Negotiated Rate	$404.80
Max. Negotiated Rate	$588.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$441.60
Rate for Payer: Aetna of CA Government/Medicare	$441.60
Rate for Payer: Cash Price	$331.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$588.80
Rate for Payer: Health Smart Auto/Commercial	$441.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$441.60
Rate for Payer: LLUH Dept of Risk Management WC	$404.80
Rate for Payer: Multiplan Commercial	$552.00

HC FISH INTERPHASE 100-300 CELLS

Facility

$515.00

Service Code	CPT 88275
Hospital Charge Code	900918011
Hospital Revenue Code	310
Min. Negotiated Rate	$51.19
Max. Negotiated Rate	$412.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$309.00
Rate for Payer: Aetna of CA Government/Medicare	$309.00
Rate for Payer: Cash Price	$231.75
Rate for Payer: Cash Price	$231.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$412.00
Rate for Payer: Health Smart Auto/Commercial	$309.00
Rate for Payer: Intervalley Health Plan Commercial	$51.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$309.00
Rate for Payer: LLUH Dept of Risk Management WC	$283.25
Rate for Payer: Multiplan Commercial	$386.25

HC FISH INTERPHASE 100-300 CELLS

Facility

$592.00

Service Code	CPT 88275
Hospital Charge Code	900918011
Hospital Revenue Code	310
Min. Negotiated Rate	$325.60
Max. Negotiated Rate	$473.60
Rate for Payer: Cash Price	$266.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$473.60
Rate for Payer: Health Smart Auto/Commercial	$355.20
Rate for Payer: LLUH Dept of Risk Management WC	$325.60
Rate for Payer: Multiplan Commercial	$444.00

HC FISH INTERPHASE 25-99 CELLS

Facility

$154.00

Service Code	CPT 88274
Hospital Charge Code	900918010
Hospital Revenue Code	310
Min. Negotiated Rate	$42.38
Max. Negotiated Rate	$123.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$92.40
Rate for Payer: Aetna of CA Government/Medicare	$92.40
Rate for Payer: Cash Price	$69.30
Rate for Payer: Cash Price	$69.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$123.20
Rate for Payer: Health Smart Auto/Commercial	$92.40
Rate for Payer: Intervalley Health Plan Commercial	$42.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$92.40
Rate for Payer: LLUH Dept of Risk Management WC	$84.70
Rate for Payer: Multiplan Commercial	$115.50

HC FISH INTERPHASE 25-99 CELLS

Facility

$213.00

Service Code	CPT 88274
Hospital Charge Code	900918010
Hospital Revenue Code	310
Min. Negotiated Rate	$117.15
Max. Negotiated Rate	$170.40
Rate for Payer: Cash Price	$95.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$170.40
Rate for Payer: Health Smart Auto/Commercial	$127.80
Rate for Payer: LLUH Dept of Risk Management WC	$117.15
Rate for Payer: Multiplan Commercial	$159.75

HC FISH PROBE CYTOGEN 10-30 CELLS

Facility

$143.00

Service Code	CPT 88273
Hospital Charge Code	900918009
Hospital Revenue Code	310
Min. Negotiated Rate	$34.81
Max. Negotiated Rate	$114.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$85.80
Rate for Payer: Aetna of CA Government/Medicare	$85.80
Rate for Payer: Cash Price	$64.35
Rate for Payer: Cash Price	$64.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$114.40
Rate for Payer: Health Smart Auto/Commercial	$85.80
Rate for Payer: Intervalley Health Plan Commercial	$34.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$85.80
Rate for Payer: LLUH Dept of Risk Management WC	$78.65
Rate for Payer: Multiplan Commercial	$107.25

Know your out-of-pocket cost for care.

All Charges