Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC FISH INTERPHASE 25-99 CELLS

Facility

$218.00

Service Code	CPT 88274
Hospital Charge Code	900918010
Hospital Revenue Code	310
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$174.40
Rate for Payer: Cash Price	$98.10
Rate for Payer: Cigna of CA HMO/PPO	$174.40
Rate for Payer: Health Smart Auto/Commercial	$130.80
Rate for Payer: LLUH Dept of Risk Management WC	$119.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$163.50

HC FISH INTERPHASE 25-99 CELLS

Facility

$157.00

Service Code	CPT 88274
Hospital Charge Code	900918010
Hospital Revenue Code	310
Min. Negotiated Rate	$86.35
Max. Negotiated Rate	$117.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$94.20
Rate for Payer: Aetna of CA Government/Medicare	$94.20
Rate for Payer: Cash Price	$70.65
Rate for Payer: Health Smart Auto/Commercial	$94.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$94.20
Rate for Payer: LLUH Dept of Risk Management WC	$86.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$117.75

HC FISH PROBE CYTOGEN 10-30 CELLS

Facility

$146.00

Service Code	CPT 88273
Hospital Charge Code	900918009
Hospital Revenue Code	310
Min. Negotiated Rate	$80.30
Max. Negotiated Rate	$109.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$87.60
Rate for Payer: Aetna of CA Government/Medicare	$87.60
Rate for Payer: Cash Price	$65.70
Rate for Payer: Health Smart Auto/Commercial	$87.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$87.60
Rate for Payer: LLUH Dept of Risk Management WC	$80.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$109.50

HC FISH PROBE CYTOGEN 10-30 CELLS

Facility

$206.00

Service Code	CPT 88273
Hospital Charge Code	900918009
Hospital Revenue Code	310
Min. Negotiated Rate	$113.30
Max. Negotiated Rate	$164.80
Rate for Payer: Cash Price	$92.70
Rate for Payer: Cigna of CA HMO/PPO	$164.80
Rate for Payer: Health Smart Auto/Commercial	$123.60
Rate for Payer: LLUH Dept of Risk Management WC	$113.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$154.50

HC FISH PROBE CYTOGEN 3-5 CELLS

Facility

$134.00

Service Code	CPT 88272
Hospital Charge Code	900918008
Hospital Revenue Code	310
Min. Negotiated Rate	$73.70
Max. Negotiated Rate	$100.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$80.40
Rate for Payer: Aetna of CA Government/Medicare	$80.40
Rate for Payer: Cash Price	$60.30
Rate for Payer: Health Smart Auto/Commercial	$80.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$80.40
Rate for Payer: LLUH Dept of Risk Management WC	$73.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$100.50

HC FISH PROBE CYTOGEN 3-5 CELLS

Facility

$186.00

Service Code	CPT 88272
Hospital Charge Code	900918008
Hospital Revenue Code	310
Min. Negotiated Rate	$102.30
Max. Negotiated Rate	$148.80
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cigna of CA HMO/PPO	$148.80
Rate for Payer: Health Smart Auto/Commercial	$111.60
Rate for Payer: LLUH Dept of Risk Management WC	$102.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$139.50

HC FISH PROBE CYTOGEN EA

Facility

$218.00

Service Code	CPT 88271
Hospital Charge Code	900918007
Hospital Revenue Code	310
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$174.40
Rate for Payer: Cash Price	$98.10
Rate for Payer: Cigna of CA HMO/PPO	$174.40
Rate for Payer: Health Smart Auto/Commercial	$130.80
Rate for Payer: LLUH Dept of Risk Management WC	$119.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$163.50

HC FISH PROBE CYTOGEN EA

Facility

$157.00

Service Code	CPT 88271
Hospital Charge Code	900918007
Hospital Revenue Code	310
Min. Negotiated Rate	$86.35
Max. Negotiated Rate	$117.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$94.20
Rate for Payer: Aetna of CA Government/Medicare	$94.20
Rate for Payer: Cash Price	$70.65
Rate for Payer: Health Smart Auto/Commercial	$94.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$94.20
Rate for Payer: LLUH Dept of Risk Management WC	$86.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$117.75

HC FISH PROBE CYTOGEN EA

Facility

$218.00

Service Code	CPT 88271 TC
Hospital Charge Code	900918007
Hospital Revenue Code	310
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$174.40
Rate for Payer: Cigna of CA HMO/PPO	$174.40
Rate for Payer: Health Smart Auto/Commercial	$130.80
Rate for Payer: Cash Price	$98.10
Rate for Payer: LLUH Dept of Risk Management WC	$119.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$163.50

HC FK 506 (TACROLIMUS)

Facility

$216.00

Service Code	CPT 80197
Hospital Charge Code	900911039
Hospital Revenue Code	301
Min. Negotiated Rate	$118.80
Max. Negotiated Rate	$172.80
Rate for Payer: Cash Price	$97.20
Rate for Payer: Cigna of CA HMO/PPO	$172.80
Rate for Payer: Health Smart Auto/Commercial	$129.60
Rate for Payer: LLUH Dept of Risk Management WC	$118.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$162.00

HC FK 506 (TACROLIMUS)

Facility

$50.00

Service Code	CPT 80197
Hospital Charge Code	900911039
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.50

HC FLUORESCENT STAIN FUNGI

Facility

$160.00

Service Code	CPT 87206
Hospital Charge Code	900912418
Hospital Revenue Code	306
Min. Negotiated Rate	$88.00
Max. Negotiated Rate	$128.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna of CA HMO/PPO	$128.00
Rate for Payer: Health Smart Auto/Commercial	$96.00
Rate for Payer: LLUH Dept of Risk Management WC	$88.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$120.00

HC FLUORESCENT STAIN FUNGI

Facility

$20.00

Service Code	CPT 87206
Hospital Charge Code	900912418
Hospital Revenue Code	306
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.00
Rate for Payer: Aetna of CA Government/Medicare	$12.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.00

HC FOLIC ACID (SERUM)

Facility

$28.00

Service Code	CPT 82746
Hospital Charge Code	900910817
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 FOLIC ACID (SERUM)

Facility

$244.00

Service Code	CPT 82746
Hospital Charge Code	900910817
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 FOOT COMPLETE

Facility

$989.00

Service Code	CPT 73630
Hospital Charge Code	909001631
Hospital Revenue Code	320
Min. Negotiated Rate	$543.95
Max. Negotiated Rate	$791.20
Rate for Payer: Cash Price	$445.05
Rate for Payer: Cigna of CA HMO/PPO	$791.20
Rate for Payer: Health Smart Auto/Commercial	$593.40
Rate for Payer: LLUH Dept of Risk Management WC	$543.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$741.75

HC FOOT COMPLETE

Facility

$989.00

Service Code	CPT 73630 TC
Hospital Charge Code	909001631
Hospital Revenue Code	320
Min. Negotiated Rate	$543.95
Max. Negotiated Rate	$791.20
Rate for Payer: Cash Price	$445.05
Rate for Payer: Cigna of CA HMO/PPO	$791.20
Rate for Payer: Health Smart Auto/Commercial	$593.40
Rate for Payer: LLUH Dept of Risk Management WC	$543.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$741.75

HC FOOT COMPLETE

Facility

$989.00

Service Code	CPT 73630 TC
Hospital Charge Code	909001631
Hospital Revenue Code	320
Min. Negotiated Rate	$543.95
Max. Negotiated Rate	$741.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$593.40
Rate for Payer: Aetna of CA Government/Medicare	$593.40
Rate for Payer: Cash Price	$445.05
Rate for Payer: Health Smart Auto/Commercial	$593.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$593.40
Rate for Payer: LLUH Dept of Risk Management WC	$543.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$741.75

HC FOOT COMPLETE

Facility

$989.00

Service Code	CPT 73630
Hospital Charge Code	909001631
Hospital Revenue Code	320
Min. Negotiated Rate	$543.95
Max. Negotiated Rate	$741.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$593.40
Rate for Payer: Aetna of CA Government/Medicare	$593.40
Rate for Payer: Cash Price	$445.05
Rate for Payer: Health Smart Auto/Commercial	$593.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$593.40
Rate for Payer: LLUH Dept of Risk Management WC	$543.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$741.75

HC FOOT LIMITED 2 VIEWS

Facility

$768.00

Service Code	CPT 73620
Hospital Charge Code	909001632
Hospital Revenue Code	320
Min. Negotiated Rate	$422.40
Max. Negotiated Rate	$614.40
Rate for Payer: Cash Price	$345.60
Rate for Payer: Cigna of CA HMO/PPO	$614.40
Rate for Payer: Health Smart Auto/Commercial	$460.80
Rate for Payer: LLUH Dept of Risk Management WC	$422.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$576.00

HC FOOT LIMITED 2 VIEWS

Facility

$768.00

Service Code	CPT 73620 TC
Hospital Charge Code	909001632
Hospital Revenue Code	320
Min. Negotiated Rate	$422.40
Max. Negotiated Rate	$614.40
Rate for Payer: Cash Price	$345.60
Rate for Payer: Cigna of CA HMO/PPO	$614.40
Rate for Payer: Health Smart Auto/Commercial	$460.80
Rate for Payer: LLUH Dept of Risk Management WC	$422.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$576.00

HC FOOT LIMITED 2 VIEWS

Facility

$768.00

Service Code	CPT 73620 TC
Hospital Charge Code	909001632
Hospital Revenue Code	320
Min. Negotiated Rate	$422.40
Max. Negotiated Rate	$576.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$460.80
Rate for Payer: Aetna of CA Government/Medicare	$460.80
Rate for Payer: Cash Price	$345.60
Rate for Payer: Health Smart Auto/Commercial	$460.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$460.80
Rate for Payer: LLUH Dept of Risk Management WC	$422.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$576.00

HC FOOT LIMITED 2 VIEWS

Facility

$768.00

Service Code	CPT 73620
Hospital Charge Code	909001632
Hospital Revenue Code	320
Min. Negotiated Rate	$422.40
Max. Negotiated Rate	$576.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$460.80
Rate for Payer: Aetna of CA Government/Medicare	$460.80
Rate for Payer: Cash Price	$345.60
Rate for Payer: Health Smart Auto/Commercial	$460.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$460.80
Rate for Payer: LLUH Dept of Risk Management WC	$422.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$576.00

HC FOREARM

Facility

$790.00

Service Code	CPT 73090
Hospital Charge Code	909001513
Hospital Revenue Code	320
Min. Negotiated Rate	$434.50
Max. Negotiated Rate	$592.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$474.00
Rate for Payer: Aetna of CA Government/Medicare	$474.00
Rate for Payer: Cash Price	$355.50
Rate for Payer: Health Smart Auto/Commercial	$474.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$474.00
Rate for Payer: LLUH Dept of Risk Management WC	$434.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$592.50

HC FOREARM

Facility

$790.00

Service Code	CPT 73090 TC
Hospital Charge Code	909001513
Hospital Revenue Code	320
Min. Negotiated Rate	$434.50
Max. Negotiated Rate	$632.00
Rate for Payer: Cash Price	$355.50
Rate for Payer: Cigna of CA HMO/PPO	$632.00
Rate for Payer: Health Smart Auto/Commercial	$474.00
Rate for Payer: LLUH Dept of Risk Management WC	$434.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$592.50

Know your out-of-pocket cost for care.

All Charges