Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC CHROM ADDL CELL COUNT EA

Facility

$52.00

Service Code	CPT 88285
Hospital Charge Code	900918013
Hospital Revenue Code	310
Min. Negotiated Rate	$28.60
Max. Negotiated Rate	$41.60
Rate for Payer: Cigna of CA HMO/PPO	$41.60
Rate for Payer: Health Smart Auto/Commercial	$31.20
Rate for Payer: Cash Price	$23.40
Rate for Payer: LLUH Dept of Risk Management WC	$28.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$39.00

HC CHROM ADDL CELL COUNT EA

Facility

$34.00

Service Code	CPT 88285
Hospital Charge Code	900918013
Hospital Revenue Code	310
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.40
Rate for Payer: Aetna of CA Government/Medicare	$20.40
Rate for Payer: Cash Price	$15.30
Rate for Payer: Health Smart Auto/Commercial	$20.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.40
Rate for Payer: LLUH Dept of Risk Management WC	$18.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.50

HC CHROM ADDL SPEC BANDING

Facility

$95.00

Service Code	CPT 88283
Hospital Charge Code	900918012
Hospital Revenue Code	310
Min. Negotiated Rate	$52.25
Max. Negotiated Rate	$71.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$57.00
Rate for Payer: Aetna of CA Government/Medicare	$57.00
Rate for Payer: Cash Price	$42.75
Rate for Payer: Health Smart Auto/Commercial	$57.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$57.00
Rate for Payer: LLUH Dept of Risk Management WC	$52.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$71.25

HC CHROM ADDL SPEC BANDING

Facility

$136.00

Service Code	CPT 88283
Hospital Charge Code	900918012
Hospital Revenue Code	310
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$108.80
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cigna of CA HMO/PPO	$108.80
Rate for Payer: Health Smart Auto/Commercial	$81.60
Rate for Payer: LLUH Dept of Risk Management WC	$74.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$102.00

HC CHROM AMNIO 15 CELLS 1 KARYO

Facility

$252.00

Service Code	CPT 88267
Hospital Charge Code	900918015
Hospital Revenue Code	310
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$189.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$151.20
Rate for Payer: Aetna of CA Government/Medicare	$151.20
Rate for Payer: Cash Price	$113.40
Rate for Payer: Health Smart Auto/Commercial	$151.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$151.20
Rate for Payer: LLUH Dept of Risk Management WC	$138.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$189.00

HC CHROM AMNIO 15 CELLS 1 KARYO

Facility

$347.00

Service Code	CPT 88267
Hospital Charge Code	900918015
Hospital Revenue Code	310
Min. Negotiated Rate	$190.85
Max. Negotiated Rate	$277.60
Rate for Payer: Cash Price	$156.15
Rate for Payer: Cigna of CA HMO/PPO	$277.60
Rate for Payer: Health Smart Auto/Commercial	$208.20
Rate for Payer: LLUH Dept of Risk Management WC	$190.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$260.25

HC CHROM AMNIO 6-12 COLN 1 KARYO

Facility

$329.00

Service Code	CPT 88269
Hospital Charge Code	900918014
Hospital Revenue Code	310
Min. Negotiated Rate	$180.95
Max. Negotiated Rate	$263.20
Rate for Payer: Cash Price	$148.05
Rate for Payer: Cigna of CA HMO/PPO	$263.20
Rate for Payer: Health Smart Auto/Commercial	$197.40
Rate for Payer: LLUH Dept of Risk Management WC	$180.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$246.75

HC CHROM AMNIO 6-12 COLN 1 KARYO

Facility

$235.00

Service Code	CPT 88269
Hospital Charge Code	900918014
Hospital Revenue Code	310
Min. Negotiated Rate	$129.25
Max. Negotiated Rate	$176.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$141.00
Rate for Payer: Aetna of CA Government/Medicare	$141.00
Rate for Payer: Cash Price	$105.75
Rate for Payer: Health Smart Auto/Commercial	$141.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$141.00
Rate for Payer: LLUH Dept of Risk Management WC	$129.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$176.25

HC CHROM ANLZ 15-20 CELLS 2 KARYO

Facility

$174.00

Service Code	CPT 88262
Hospital Charge Code	900918020
Hospital Revenue Code	310
Min. Negotiated Rate	$95.70
Max. Negotiated Rate	$130.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$104.40
Rate for Payer: Aetna of CA Government/Medicare	$104.40
Rate for Payer: Cash Price	$78.30
Rate for Payer: Health Smart Auto/Commercial	$104.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$104.40
Rate for Payer: LLUH Dept of Risk Management WC	$95.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$130.50

HC CHROM ANLZ 15-20 CELLS 2 KARYO

Facility

$245.00

Service Code	CPT 88262 TC
Hospital Charge Code	900918020
Hospital Revenue Code	310
Min. Negotiated Rate	$134.75
Max. Negotiated Rate	$196.00
Rate for Payer: Cash Price	$110.25
Rate for Payer: Cigna of CA HMO/PPO	$196.00
Rate for Payer: Health Smart Auto/Commercial	$147.00
Rate for Payer: LLUH Dept of Risk Management WC	$134.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$183.75

HC CHROM ANLZ 15-20 CELLS 2 KARYO

Facility

$245.00

Service Code	CPT 88262
Hospital Charge Code	900918020
Hospital Revenue Code	310
Min. Negotiated Rate	$134.75
Max. Negotiated Rate	$196.00
Rate for Payer: Cash Price	$110.25
Rate for Payer: Cigna of CA HMO/PPO	$196.00
Rate for Payer: Health Smart Auto/Commercial	$147.00
Rate for Payer: LLUH Dept of Risk Management WC	$134.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$183.75

HC CHROM ANLZ 20-25 CELLS

Facility

$245.00

Service Code	CPT 88264 TC
Hospital Charge Code	900918016
Hospital Revenue Code	310
Min. Negotiated Rate	$134.75
Max. Negotiated Rate	$196.00
Rate for Payer: Cash Price	$110.25
Rate for Payer: Cigna of CA HMO/PPO	$196.00
Rate for Payer: Health Smart Auto/Commercial	$147.00
Rate for Payer: LLUH Dept of Risk Management WC	$134.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$183.75

HC CHROM ANLZ 20-25 CELLS

Facility

$174.00

Service Code	CPT 88264
Hospital Charge Code	900918016
Hospital Revenue Code	310
Min. Negotiated Rate	$95.70
Max. Negotiated Rate	$130.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$104.40
Rate for Payer: Aetna of CA Government/Medicare	$104.40
Rate for Payer: Cash Price	$78.30
Rate for Payer: Health Smart Auto/Commercial	$104.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$104.40
Rate for Payer: LLUH Dept of Risk Management WC	$95.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$130.50

HC CHROM ANLZ 20-25 CELLS

Facility

$245.00

Service Code	CPT 88264
Hospital Charge Code	900918016
Hospital Revenue Code	310
Min. Negotiated Rate	$134.75
Max. Negotiated Rate	$196.00
Rate for Payer: Cash Price	$110.25
Rate for Payer: Cigna of CA HMO/PPO	$196.00
Rate for Payer: Health Smart Auto/Commercial	$147.00
Rate for Payer: LLUH Dept of Risk Management WC	$134.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$183.75

HC CHROM ANLZ 45 CEL MSAIC 2 KRYO

Facility

$297.00

Service Code	CPT 88263
Hospital Charge Code	900918017
Hospital Revenue Code	310
Min. Negotiated Rate	$163.35
Max. Negotiated Rate	$237.60
Rate for Payer: Cash Price	$133.65
Rate for Payer: Cigna of CA HMO/PPO	$237.60
Rate for Payer: Health Smart Auto/Commercial	$178.20
Rate for Payer: LLUH Dept of Risk Management WC	$163.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$222.75

HC CHROM ANLZ 45 CEL MSAIC 2 KRYO

Facility

$213.00

Service Code	CPT 88263
Hospital Charge Code	900918017
Hospital Revenue Code	310
Min. Negotiated Rate	$117.15
Max. Negotiated Rate	$159.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$127.80
Rate for Payer: Aetna of CA Government/Medicare	$127.80
Rate for Payer: Cash Price	$95.85
Rate for Payer: Health Smart Auto/Commercial	$127.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$127.80
Rate for Payer: LLUH Dept of Risk Management WC	$117.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$159.75

HC CHROM ANLZ 5 CELLS 1 KARYO

Facility

$297.00

Service Code	CPT 88261
Hospital Charge Code	900918019
Hospital Revenue Code	310
Min. Negotiated Rate	$163.35
Max. Negotiated Rate	$222.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$178.20
Rate for Payer: Aetna of CA Government/Medicare	$178.20
Rate for Payer: Cash Price	$133.65
Rate for Payer: Health Smart Auto/Commercial	$178.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$178.20
Rate for Payer: LLUH Dept of Risk Management WC	$163.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$222.75

HC CHROM ANLZ 5 CELLS 1 KARYO

Facility

$412.00

Service Code	CPT 88261
Hospital Charge Code	900918019
Hospital Revenue Code	310
Min. Negotiated Rate	$226.60
Max. Negotiated Rate	$329.60
Rate for Payer: Cash Price	$185.40
Rate for Payer: Cigna of CA HMO/PPO	$329.60
Rate for Payer: Health Smart Auto/Commercial	$247.20
Rate for Payer: LLUH Dept of Risk Management WC	$226.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$309.00

HC CHROM ANLZ ADDL KARYO

Facility

$58.00

Service Code	CPT 88280
Hospital Charge Code	900918018
Hospital Revenue Code	310
Min. Negotiated Rate	$31.90
Max. Negotiated Rate	$46.40
Rate for Payer: Cash Price	$26.10
Rate for Payer: Cigna of CA HMO/PPO	$46.40
Rate for Payer: Health Smart Auto/Commercial	$34.80
Rate for Payer: LLUH Dept of Risk Management WC	$31.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$43.50

HC CHROM ANLZ ADDL KARYO

Facility

$39.00

Service Code	CPT 88280
Hospital Charge Code	900918018
Hospital Revenue Code	310
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 CIPROFLOXACIN E TEST

Facility

$11.00

Service Code	CPT 87181
Hospital Charge Code	900912443
Hospital Revenue Code	306
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.60
Rate for Payer: Aetna of CA Government/Medicare	$6.60
Rate for Payer: Cash Price	$4.95
Rate for Payer: Health Smart Auto/Commercial	$6.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.60
Rate for Payer: LLUH Dept of Risk Management WC	$6.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.25

HC CIPROFLOXACIN E TEST

Facility

$87.00

Service Code	CPT 87181
Hospital Charge Code	900912443
Hospital Revenue Code	306
Min. Negotiated Rate	$47.85
Max. Negotiated Rate	$69.60
Rate for Payer: Cash Price	$39.15
Rate for Payer: Cigna of CA HMO/PPO	$69.60
Rate for Payer: Health Smart Auto/Commercial	$52.20
Rate for Payer: LLUH Dept of Risk Management WC	$47.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$65.25

HC CIRC ANTICOAG SCRN

Facility

$25.00

Service Code	CPT 85732
Hospital Charge Code	900910015
Hospital Revenue Code	305
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$18.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.00
Rate for Payer: Aetna of CA Government/Medicare	$15.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.75

HC CIRC ANTICOAG SCRN

Facility

$351.00

Service Code	CPT 85732
Hospital Charge Code	900910015
Hospital Revenue Code	305
Min. Negotiated Rate	$193.05
Max. Negotiated Rate	$280.80
Rate for Payer: Cash Price	$157.95
Rate for Payer: Cigna of CA HMO/PPO	$280.80
Rate for Payer: Health Smart Auto/Commercial	$210.60
Rate for Payer: LLUH Dept of Risk Management WC	$193.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$263.25

HC CITRULLINATED PEPTIDE AB

Facility

$49.00

Service Code	CPT 86200
Hospital Charge Code	900913554
Hospital Revenue Code	302
Min. Negotiated Rate	$26.95
Max. Negotiated Rate	$36.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$29.40
Rate for Payer: Aetna of CA Government/Medicare	$29.40
Rate for Payer: Cash Price	$22.05
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$29.40
Rate for Payer: LLUH Dept of Risk Management WC	$26.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.75

Know your out-of-pocket cost for care.

All Charges