Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC CBC WO DIFFERENTIAL

Facility

$16.00

Service Code	CPT 85027
Hospital Charge Code	900910086
Hospital Revenue Code	305
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.60
Rate for Payer: Aetna of CA Government/Medicare	$9.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Smart Auto/Commercial	$9.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.60
Rate for Payer: LLUH Dept of Risk Management WC	$8.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.00

HC CBC WO DIFFERENTIAL

Facility

$109.00

Service Code	CPT 85027
Hospital Charge Code	900910086
Hospital Revenue Code	305
Min. Negotiated Rate	$59.95
Max. Negotiated Rate	$87.20
Rate for Payer: Cash Price	$49.05
Rate for Payer: Cigna of CA HMO/PPO	$87.20
Rate for Payer: Health Smart Auto/Commercial	$65.40
Rate for Payer: LLUH Dept of Risk Management WC	$59.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$81.75

HC CBC W WBC AUTO DIFF

Facility

$16.00

Service Code	CPT 85025
Hospital Charge Code	900910092
Hospital Revenue Code	305
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.60
Rate for Payer: Aetna of CA Government/Medicare	$9.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Smart Auto/Commercial	$9.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.60
Rate for Payer: LLUH Dept of Risk Management WC	$8.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.00

HC CBC W WBC AUTO DIFF

Facility

$171.00

Service Code	CPT 85025
Hospital Charge Code	900910092
Hospital Revenue Code	305
Min. Negotiated Rate	$94.05
Max. Negotiated Rate	$136.80
Rate for Payer: Cash Price	$76.95
Rate for Payer: Cigna of CA HMO/PPO	$136.80
Rate for Payer: Health Smart Auto/Commercial	$102.60
Rate for Payer: LLUH Dept of Risk Management WC	$94.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$128.25

HC CBC W WBC AUTO DIFFERENTIAL INDIV

Facility

$153.00

Service Code	CPT 85025
Hospital Charge Code	900912018
Hospital Revenue Code	305
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$122.40
Rate for Payer: Cash Price	$68.85
Rate for Payer: Cigna of CA HMO/PPO	$122.40
Rate for Payer: Health Smart Auto/Commercial	$91.80
Rate for Payer: LLUH Dept of Risk Management WC	$84.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$114.75

HC CBC W WBC AUTO DIFFERENTIAL INDIV

Facility

$16.00

Service Code	CPT 85025
Hospital Charge Code	900912018
Hospital Revenue Code	305
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.60
Rate for Payer: Aetna of CA Government/Medicare	$9.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Smart Auto/Commercial	$9.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.60
Rate for Payer: LLUH Dept of Risk Management WC	$8.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.00

HC CBC W WO DIFFERENTIAL INDIVIDUAL

Facility

$99.00

Service Code	CPT 85027
Hospital Charge Code	900912019
Hospital Revenue Code	305
Min. Negotiated Rate	$54.45
Max. Negotiated Rate	$79.20
Rate for Payer: Cash Price	$44.55
Rate for Payer: Cigna of CA HMO/PPO	$79.20
Rate for Payer: Health Smart Auto/Commercial	$59.40
Rate for Payer: LLUH Dept of Risk Management WC	$54.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$74.25

HC CBC W WO DIFFERENTIAL INDIVIDUAL

Facility

$16.00

Service Code	CPT 85027
Hospital Charge Code	900912019
Hospital Revenue Code	305
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.60
Rate for Payer: Aetna of CA Government/Medicare	$9.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Smart Auto/Commercial	$9.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.60
Rate for Payer: LLUH Dept of Risk Management WC	$8.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.00

HC C DIFFICILE TOXIN A/B ASSAY

Facility

$39.00

Service Code	CPT 87324
Hospital Charge Code	900911750
Hospital Revenue Code	306
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.40
Rate for Payer: Aetna of CA Government/Medicare	$23.40
Rate for Payer: Cash Price	$17.55
Rate for Payer: Health Smart Auto/Commercial	$23.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.40
Rate for Payer: LLUH Dept of Risk Management WC	$21.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.25

HC C DIFFICILE TOXIN A/B ASSAY

Facility

$250.00

Service Code	CPT 87324
Hospital Charge Code	900911750
Hospital Revenue Code	306
Min. Negotiated Rate	$137.50
Max. Negotiated Rate	$200.00
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cigna of CA HMO/PPO	$200.00
Rate for Payer: Health Smart Auto/Commercial	$150.00
Rate for Payer: LLUH Dept of Risk Management WC	$137.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$187.50

HC CEFINASE

Facility

$18.00

Service Code	CPT 87185
Hospital Charge Code	900912424
Hospital Revenue Code	306
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$13.50
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: Health Smart Auto/Commercial	$10.80
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 Beech St/Commercial/PHCS	$13.50

HC CEFINASE

Facility

$105.00

Service Code	CPT 87185
Hospital Charge Code	900912424
Hospital Revenue Code	306
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$84.00
Rate for Payer: Cash Price	$47.25
Rate for Payer: Cigna of CA HMO/PPO	$84.00
Rate for Payer: Health Smart Auto/Commercial	$63.00
Rate for Payer: LLUH Dept of Risk Management WC	$57.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$78.75

HC CELL COUNT & DIFF

Facility

$292.00

Service Code	CPT 89051
Hospital Charge Code	900910124
Hospital Revenue Code	300
Min. Negotiated Rate	$160.60
Max. Negotiated Rate	$233.60
Rate for Payer: Cash Price	$131.40
Rate for Payer: Cigna of CA HMO/PPO	$233.60
Rate for Payer: Health Smart Auto/Commercial	$175.20
Rate for Payer: LLUH Dept of Risk Management WC	$160.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$219.00

HC CELL COUNT & DIFF

Facility

$21.00

Service Code	CPT 89051
Hospital Charge Code	900910124
Hospital Revenue Code	300
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 CELL EXPANSION

Facility

$426.00

Service Code	CPT 88233
Hospital Charge Code	900918001
Hospital Revenue Code	310
Min. Negotiated Rate	$234.30
Max. Negotiated Rate	$319.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$255.60
Rate for Payer: Aetna of CA Government/Medicare	$255.60
Rate for Payer: Cash Price	$191.70
Rate for Payer: Health Smart Auto/Commercial	$255.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$255.60
Rate for Payer: LLUH Dept of Risk Management WC	$234.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$319.50

HC CELL EXPANSION

Facility

$393.00

Service Code	CPT 88233
Hospital Charge Code	900918001
Hospital Revenue Code	310
Min. Negotiated Rate	$216.15
Max. Negotiated Rate	$314.40
Rate for Payer: Cash Price	$176.85
Rate for Payer: Cigna of CA HMO/PPO	$314.40
Rate for Payer: Health Smart Auto/Commercial	$235.80
Rate for Payer: LLUH Dept of Risk Management WC	$216.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$294.75

HC CELL MORPHOLOGY (VISUAL)

Facility

$13.00

Service Code	CPT 85007
Hospital Charge Code	900910073
Hospital Revenue Code	305
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.80
Rate for Payer: Aetna of CA Government/Medicare	$7.80
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC CELL MORPHOLOGY (VISUAL)

Facility

$131.00

Service Code	CPT 85007
Hospital Charge Code	900910073
Hospital Revenue Code	305
Min. Negotiated Rate	$72.05
Max. Negotiated Rate	$104.80
Rate for Payer: Cash Price	$58.95
Rate for Payer: Cigna of CA HMO/PPO	$104.80
Rate for Payer: Health Smart Auto/Commercial	$78.60
Rate for Payer: LLUH Dept of Risk Management WC	$72.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$98.25

HC CELL MORPHOLOGY VISUAL INDIVIDUAL

Facility

$131.00

Service Code	CPT 85007
Hospital Charge Code	900912021
Hospital Revenue Code	305
Min. Negotiated Rate	$72.05
Max. Negotiated Rate	$104.80
Rate for Payer: Cash Price	$58.95
Rate for Payer: Cigna of CA HMO/PPO	$104.80
Rate for Payer: Health Smart Auto/Commercial	$78.60
Rate for Payer: LLUH Dept of Risk Management WC	$72.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$98.25

HC CELL MORPHOLOGY VISUAL INDIVIDUAL

Facility

$13.00

Service Code	CPT 85007
Hospital Charge Code	900912021
Hospital Revenue Code	305
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.80
Rate for Payer: Aetna of CA Government/Medicare	$7.80
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC CENTROMERE AB

Facility

$162.00

Service Code	CPT 86255
Hospital Charge Code	900913527
Hospital Revenue Code	302
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 CENTROMERE AB

Facility

$22.00

Service Code	CPT 86255
Hospital Charge Code	900913527
Hospital Revenue Code	302
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.20
Rate for Payer: Aetna of CA Government/Medicare	$13.20
Rate for Payer: Cash Price	$9.90
Rate for Payer: Health Smart Auto/Commercial	$13.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.20
Rate for Payer: LLUH Dept of Risk Management WC	$12.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.50

HC CERULOPLASMIN

Facility

$138.00

Service Code	CPT 82390
Hospital Charge Code	900910839
Hospital Revenue Code	301
Min. Negotiated Rate	$75.90
Max. Negotiated Rate	$110.40
Rate for Payer: Cash Price	$62.10
Rate for Payer: Cigna of CA HMO/PPO	$110.40
Rate for Payer: Health Smart Auto/Commercial	$82.80
Rate for Payer: LLUH Dept of Risk Management WC	$75.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$103.50

HC CERULOPLASMIN

Facility

$31.00

Service Code	CPT 82390
Hospital Charge Code	900910839
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 CHLAMYDIA AMPLIFICATION

Facility

$356.00

Service Code	CPT 87491
Hospital Charge Code	900912304
Hospital Revenue Code	301
Min. Negotiated Rate	$195.80
Max. Negotiated Rate	$284.80
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cigna of CA HMO/PPO	$284.80
Rate for Payer: Health Smart Auto/Commercial	$213.60
Rate for Payer: LLUH Dept of Risk Management WC	$195.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$267.00

Know your out-of-pocket cost for care.

All Charges