Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC FA STAIN INFLUENZA A

Facility

$339.00

Service Code	CPT 87276
Hospital Charge Code	900911781
Hospital Revenue Code	306
Min. Negotiated Rate	$186.45
Max. Negotiated Rate	$271.20
Rate for Payer: Cash Price	$152.55
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$254.25

HC FA STAIN INFLUENZA A

Facility

$39.00

Service Code	CPT 87276
Hospital Charge Code	900911781
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 FA STAIN INFLUENZA B

Facility

$39.00

Service Code	CPT 87275
Hospital Charge Code	900911782
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 FA STAIN INFLUENZA B

Facility

$339.00

Service Code	CPT 87275
Hospital Charge Code	900911782
Hospital Revenue Code	306
Min. Negotiated Rate	$186.45
Max. Negotiated Rate	$271.20
Rate for Payer: Cash Price	$152.55
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$254.25

HC FA STAIN LEGIONELLA

Facility

$339.00

Service Code	CPT 87278
Hospital Charge Code	900911733
Hospital Revenue Code	306
Min. Negotiated Rate	$186.45
Max. Negotiated Rate	$271.20
Rate for Payer: Cash Price	$152.55
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$254.25

HC FA STAIN LEGIONELLA

Facility

$39.00

Service Code	CPT 87278
Hospital Charge Code	900911733
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 FA STAIN PARAINFLUENZA

Facility

$339.00

Service Code	CPT 87279
Hospital Charge Code	900911783
Hospital Revenue Code	306
Min. Negotiated Rate	$186.45
Max. Negotiated Rate	$271.20
Rate for Payer: Cash Price	$152.55
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$254.25

HC FA STAIN PARAINFLUENZA

Facility

$39.00

Service Code	CPT 87279
Hospital Charge Code	900911783
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 FERRITIN

Facility

$244.00

Service Code	CPT 82728
Hospital Charge Code	900910819
Hospital Revenue Code	301
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$195.20
Rate for Payer: Cash Price	$109.80
Rate for Payer: Cigna of CA HMO/PPO	$195.20
Rate for Payer: Health Smart Auto/Commercial	$146.40
Rate for Payer: LLUH Dept of Risk Management WC	$134.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$183.00

HC FERRITIN

Facility

$25.00

Service Code	CPT 82728
Hospital Charge Code	900910819
Hospital Revenue Code	301
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 FETAL FIBRONECTIN

Facility

$185.00

Service Code	CPT 82731
Hospital Charge Code	900912319
Hospital Revenue Code	304
Min. Negotiated Rate	$101.75
Max. Negotiated Rate	$138.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$111.00
Rate for Payer: Aetna of CA Government/Medicare	$111.00
Rate for Payer: Cash Price	$83.25
Rate for Payer: Health Smart Auto/Commercial	$111.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$111.00
Rate for Payer: LLUH Dept of Risk Management WC	$101.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$138.75

HC FETAL FIBRONECTIN

Facility

$1,607.00

Service Code	CPT 82731
Hospital Charge Code	900912319
Hospital Revenue Code	304
Min. Negotiated Rate	$883.85
Max. Negotiated Rate	$1,285.60
Rate for Payer: Cash Price	$723.15
Rate for Payer: Cigna of CA HMO/PPO	$1,285.60
Rate for Payer: Health Smart Auto/Commercial	$964.20
Rate for Payer: LLUH Dept of Risk Management WC	$883.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,205.25

HC FETAL LUNG MATURITY (FLM)

Facility

$486.00

Service Code	CPT 83663
Hospital Charge Code	900910962
Hospital Revenue Code	301
Min. Negotiated Rate	$267.30
Max. Negotiated Rate	$388.80
Rate for Payer: Cash Price	$218.70
Rate for Payer: Cigna of CA HMO/PPO	$388.80
Rate for Payer: Health Smart Auto/Commercial	$291.60
Rate for Payer: LLUH Dept of Risk Management WC	$267.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$364.50

HC FETAL LUNG MATURITY (FLM)

Facility

$486.00

Service Code	CPT 83663
Hospital Charge Code	900910962
Hospital Revenue Code	301
Min. Negotiated Rate	$267.30
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$291.60
Rate for Payer: Aetna of CA Government/Medicare	$291.60
Rate for Payer: Cash Price	$218.70
Rate for Payer: Health Smart Auto/Commercial	$291.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$291.60
Rate for Payer: LLUH Dept of Risk Management WC	$267.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$364.50

HC FIBRIN DEGRAD SPLIT PRODUCTS

Facility

$27.00

Service Code	CPT 85362
Hospital Charge Code	900910069
Hospital Revenue Code	305
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$20.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.20
Rate for Payer: Aetna of CA Government/Medicare	$16.20
Rate for Payer: Cash Price	$12.15
Rate for Payer: Health Smart Auto/Commercial	$16.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.20
Rate for Payer: LLUH Dept of Risk Management WC	$14.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.25

HC FIBRIN DEGRAD SPLIT PRODUCTS

Facility

$276.00

Service Code	CPT 85362
Hospital Charge Code	900910069
Hospital Revenue Code	305
Min. Negotiated Rate	$151.80
Max. Negotiated Rate	$220.80
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cigna of CA HMO/PPO	$220.80
Rate for Payer: Health Smart Auto/Commercial	$165.60
Rate for Payer: LLUH Dept of Risk Management WC	$151.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$207.00

HC FIBRINOGEN ASSAY

Facility

$315.00

Service Code	CPT 85384
Hospital Charge Code	900910013
Hospital Revenue Code	305
Min. Negotiated Rate	$173.25
Max. Negotiated Rate	$252.00
Rate for Payer: Cash Price	$141.75
Rate for Payer: Cigna of CA HMO/PPO	$252.00
Rate for Payer: Health Smart Auto/Commercial	$189.00
Rate for Payer: LLUH Dept of Risk Management WC	$173.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$236.25

HC FIBRINOGEN ASSAY

Facility

$32.00

Service Code	CPT 85384
Hospital Charge Code	900910013
Hospital Revenue Code	305
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.20
Rate for Payer: Aetna of CA Government/Medicare	$19.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Smart Auto/Commercial	$19.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.20
Rate for Payer: LLUH Dept of Risk Management WC	$17.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.00

HC FINGERS MIN 2 VIEWS

Facility

$663.00

Service Code	CPT 73140
Hospital Charge Code	909001521
Hospital Revenue Code	320
Min. Negotiated Rate	$364.65
Max. Negotiated Rate	$497.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$397.80
Rate for Payer: Aetna of CA Government/Medicare	$397.80
Rate for Payer: Cash Price	$298.35
Rate for Payer: Health Smart Auto/Commercial	$397.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$397.80
Rate for Payer: LLUH Dept of Risk Management WC	$364.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$497.25

HC FINGERS MIN 2 VIEWS

Facility

$663.00

Service Code	CPT 73140
Hospital Charge Code	909001521
Hospital Revenue Code	320
Min. Negotiated Rate	$364.65
Max. Negotiated Rate	$530.40
Rate for Payer: Cash Price	$298.35
Rate for Payer: Cigna of CA HMO/PPO	$530.40
Rate for Payer: Health Smart Auto/Commercial	$397.80
Rate for Payer: LLUH Dept of Risk Management WC	$364.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$497.25

HC FINGERS MIN 2 VIEWS

Facility

$663.00

Service Code	CPT 73140 TC
Hospital Charge Code	909001521
Hospital Revenue Code	320
Min. Negotiated Rate	$364.65
Max. Negotiated Rate	$530.40
Rate for Payer: Cash Price	$298.35
Rate for Payer: Cigna of CA HMO/PPO	$530.40
Rate for Payer: Health Smart Auto/Commercial	$397.80
Rate for Payer: LLUH Dept of Risk Management WC	$364.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$497.25

HC FINGERS MIN 2 VIEWS

Facility

$663.00

Service Code	CPT 73140 TC
Hospital Charge Code	909001521
Hospital Revenue Code	320
Min. Negotiated Rate	$364.65
Max. Negotiated Rate	$497.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$397.80
Rate for Payer: Aetna of CA Government/Medicare	$397.80
Rate for Payer: Cash Price	$298.35
Rate for Payer: Health Smart Auto/Commercial	$397.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$397.80
Rate for Payer: LLUH Dept of Risk Management WC	$364.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$497.25

HC FISH INTERPHASE 100-300 CELLS

Facility

$230.00

Service Code	CPT 88275
Hospital Charge Code	900918011
Hospital Revenue Code	310
Min. Negotiated Rate	$126.50
Max. Negotiated Rate	$172.50
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: Health Smart Auto/Commercial	$138.00
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 Beech St/Commercial/PHCS	$172.50

HC FISH INTERPHASE 100-300 CELLS

Facility

$322.00

Service Code	CPT 88275 TC
Hospital Charge Code	900918011
Hospital Revenue Code	310
Min. Negotiated Rate	$177.10
Max. Negotiated Rate	$257.60
Rate for Payer: Cash Price	$144.90
Rate for Payer: Cigna of CA HMO/PPO	$257.60
Rate for Payer: Health Smart Auto/Commercial	$193.20
Rate for Payer: LLUH Dept of Risk Management WC	$177.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$241.50

HC FISH INTERPHASE 100-300 CELLS

Facility

$322.00

Service Code	CPT 88275
Hospital Charge Code	900918011
Hospital Revenue Code	310
Min. Negotiated Rate	$177.10
Max. Negotiated Rate	$257.60
Rate for Payer: Cash Price	$144.90
Rate for Payer: Cigna of CA HMO/PPO	$257.60
Rate for Payer: Health Smart Auto/Commercial	$193.20
Rate for Payer: LLUH Dept of Risk Management WC	$177.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$241.50

Know your out-of-pocket cost for care.

All Charges