Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC LAB REF CALIFORNIA ENCEPH AB IGM

Facility

$21.00

Service Code	CPT 86651
Hospital Charge Code	900912654
Hospital Revenue Code	302
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 LAB REF CHLAMYDIA PNEUMONIA

Facility

$348.00

Service Code	CPT 87486 90
Hospital Charge Code	900912516
Hospital Revenue Code	306
Min. Negotiated Rate	$191.40
Max. Negotiated Rate	$278.40
Rate for Payer: Cash Price	$156.60
Rate for Payer: Cigna of CA HMO/PPO	$278.40
Rate for Payer: Health Smart Auto/Commercial	$208.80
Rate for Payer: LLUH Dept of Risk Management WC	$191.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$261.00

HC LAB REF CHLAMYDIA PNEUMONIA

Facility

$348.00

Service Code	CPT 87486
Hospital Charge Code	900912516
Hospital Revenue Code	306
Min. Negotiated Rate	$191.40
Max. Negotiated Rate	$278.40
Rate for Payer: Cash Price	$156.60
Rate for Payer: Cigna of CA HMO/PPO	$278.40
Rate for Payer: Health Smart Auto/Commercial	$208.80
Rate for Payer: LLUH Dept of Risk Management WC	$191.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$261.00

HC LAB REF CHLAMYDIA PNEUMONIA

Facility

$348.00

Service Code	CPT 87486
Hospital Charge Code	900912516
Hospital Revenue Code	306
Min. Negotiated Rate	$191.40
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$208.80
Rate for Payer: Aetna of CA Government/Medicare	$208.80
Rate for Payer: Cash Price	$156.60
Rate for Payer: Health Smart Auto/Commercial	$208.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$208.80
Rate for Payer: LLUH Dept of Risk Management WC	$191.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$261.00

HC LAB REF CHLAMYDIA PNEUMONIA

Facility

$348.00

Service Code	CPT 87486 90
Hospital Charge Code	900912516
Hospital Revenue Code	306
Min. Negotiated Rate	$191.40
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$208.80
Rate for Payer: Aetna of CA Government/Medicare	$208.80
Rate for Payer: Cash Price	$156.60
Rate for Payer: Health Smart Auto/Commercial	$208.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$208.80
Rate for Payer: LLUH Dept of Risk Management WC	$191.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$261.00

HC LAB REF CHORIONIC VILLUS

Facility

$288.00

Service Code	CPT 88267
Hospital Charge Code	900912555
Hospital Revenue Code	310
Min. Negotiated Rate	$158.40
Max. Negotiated Rate	$216.00
Rate for Payer: Health Smart Auto/Commercial	$172.80
Rate for Payer: Cash Price	$129.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$172.80
Rate for Payer: Aetna of CA Government/Medicare	$172.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$172.80
Rate for Payer: LLUH Dept of Risk Management WC	$158.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$216.00

HC LAB REF CHORIONIC VILLUS

Facility

$288.00

Service Code	CPT 88267
Hospital Charge Code	900912555
Hospital Revenue Code	310
Min. Negotiated Rate	$158.40
Max. Negotiated Rate	$230.40
Rate for Payer: Cash Price	$129.60
Rate for Payer: Cigna of CA HMO/PPO	$230.40
Rate for Payer: Health Smart Auto/Commercial	$172.80
Rate for Payer: LLUH Dept of Risk Management WC	$158.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$216.00

HC LAB REF CHROMOSOMAL IN SITU HYBRIDIZAT

Facility

$328.00

Service Code	CPT 88273
Hospital Charge Code	900912581
Hospital Revenue Code	310
Min. Negotiated Rate	$180.40
Max. Negotiated Rate	$246.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$196.80
Rate for Payer: Aetna of CA Government/Medicare	$196.80
Rate for Payer: Cash Price	$147.60
Rate for Payer: Health Smart Auto/Commercial	$196.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$196.80
Rate for Payer: LLUH Dept of Risk Management WC	$180.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$246.00

HC LAB REF CHROMOSOMAL IN SITU HYBRIDIZAT

Facility

$328.00

Service Code	CPT 88273
Hospital Charge Code	900912581
Hospital Revenue Code	310
Min. Negotiated Rate	$180.40
Max. Negotiated Rate	$262.40
Rate for Payer: Cash Price	$147.60
Rate for Payer: Cigna of CA HMO/PPO	$262.40
Rate for Payer: Health Smart Auto/Commercial	$196.80
Rate for Payer: LLUH Dept of Risk Management WC	$180.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$246.00

HC LAB REF CHROMOSOME ANALYSIS 20-25 CELL

Facility

$129.00

Service Code	CPT 88299
Hospital Charge Code	900912794
Hospital Revenue Code	310
Min. Negotiated Rate	$70.95
Max. Negotiated Rate	$103.20
Rate for Payer: Cash Price	$58.05
Rate for Payer: Cigna of CA HMO/PPO	$103.20
Rate for Payer: Health Smart Auto/Commercial	$77.40
Rate for Payer: LLUH Dept of Risk Management WC	$70.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$96.75

HC LAB REF CHROMOSOME ANALYSIS 20-25 CELL

Facility

$129.00

Service Code	CPT 88299 90
Hospital Charge Code	900912794
Hospital Revenue Code	310
Min. Negotiated Rate	$70.95
Max. Negotiated Rate	$103.20
Rate for Payer: Cash Price	$58.05
Rate for Payer: Cigna of CA HMO/PPO	$103.20
Rate for Payer: Health Smart Auto/Commercial	$77.40
Rate for Payer: LLUH Dept of Risk Management WC	$70.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$96.75

HC LAB REF CHROMOSOME ANALYSIS 20-25 CELL

Facility

$129.00

Service Code	CPT 88299
Hospital Charge Code	900912794
Hospital Revenue Code	310
Min. Negotiated Rate	$70.95
Max. Negotiated Rate	$96.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$77.40
Rate for Payer: Aetna of CA Government/Medicare	$77.40
Rate for Payer: Cash Price	$58.05
Rate for Payer: Health Smart Auto/Commercial	$77.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$77.40
Rate for Payer: LLUH Dept of Risk Management WC	$70.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$96.75

HC LAB REF CHROMOSOME ANALYSIS 20-25 CELL

Facility

$129.00

Service Code	CPT 88299 90
Hospital Charge Code	900912794
Hospital Revenue Code	310
Min. Negotiated Rate	$70.95
Max. Negotiated Rate	$96.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$77.40
Rate for Payer: Aetna of CA Government/Medicare	$77.40
Rate for Payer: Cash Price	$58.05
Rate for Payer: Health Smart Auto/Commercial	$77.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$77.40
Rate for Payer: LLUH Dept of Risk Management WC	$70.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$96.75

HC LAB REF CHROMOSOME IN SITU HYB 10-30 C

Facility

$52.00

Service Code	CPT 88273 90
Hospital Charge Code	900912795
Hospital Revenue Code	310
Min. Negotiated Rate	$28.60
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$31.20
Rate for Payer: Aetna of CA Government/Medicare	$31.20
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Smart Auto/Commercial	$31.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$31.20
Rate for Payer: LLUH Dept of Risk Management WC	$28.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$39.00

HC LAB REF CHROMOSOME IN SITU HYB 10-30 C

Facility

$52.00

Service Code	CPT 88273
Hospital Charge Code	900912795
Hospital Revenue Code	310
Min. Negotiated Rate	$28.60
Max. Negotiated Rate	$41.60
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cigna of CA HMO/PPO	$41.60
Rate for Payer: Health Smart Auto/Commercial	$31.20
Rate for Payer: LLUH Dept of Risk Management WC	$28.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$39.00

HC LAB REF CHROMOSOME IN SITU HYB 10-30 C

Facility

$52.00

Service Code	CPT 88273 90
Hospital Charge Code	900912795
Hospital Revenue Code	310
Min. Negotiated Rate	$28.60
Max. Negotiated Rate	$41.60
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cigna of CA HMO/PPO	$41.60
Rate for Payer: Health Smart Auto/Commercial	$31.20
Rate for Payer: LLUH Dept of Risk Management WC	$28.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$39.00

HC LAB REF CHROMOSOME IN SITU HYB 10-30 C

Facility

$52.00

Service Code	CPT 88273
Hospital Charge Code	900912795
Hospital Revenue Code	310
Min. Negotiated Rate	$28.60
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$31.20
Rate for Payer: Aetna of CA Government/Medicare	$31.20
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Smart Auto/Commercial	$31.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$31.20
Rate for Payer: LLUH Dept of Risk Management WC	$28.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$39.00

HC LAB REF CHROMOSOME INTERP & REPORT

Facility

$163.00

Service Code	CPT 88291
Hospital Charge Code	900910747
Hospital Revenue Code	310
Min. Negotiated Rate	$89.65
Max. Negotiated Rate	$130.40
Rate for Payer: Cash Price	$73.35
Rate for Payer: Cigna of CA HMO/PPO	$130.40
Rate for Payer: Health Smart Auto/Commercial	$97.80
Rate for Payer: LLUH Dept of Risk Management WC	$89.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$122.25

HC LAB REF CHROMOSOME INTERP & REPORT

Facility

$163.00

Service Code	CPT 88291
Hospital Charge Code	900910747
Hospital Revenue Code	310
Min. Negotiated Rate	$89.65
Max. Negotiated Rate	$122.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$97.80
Rate for Payer: Aetna of CA Government/Medicare	$97.80
Rate for Payer: Cash Price	$73.35
Rate for Payer: Health Smart Auto/Commercial	$97.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$97.80
Rate for Payer: LLUH Dept of Risk Management WC	$89.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$122.25

HC LAB REF CHROMOSOME INTERP & REPORT

Facility

$163.00

Service Code	CPT 88291 90
Hospital Charge Code	900910747
Hospital Revenue Code	310
Min. Negotiated Rate	$89.65
Max. Negotiated Rate	$122.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$97.80
Rate for Payer: Aetna of CA Government/Medicare	$97.80
Rate for Payer: Cash Price	$73.35
Rate for Payer: Health Smart Auto/Commercial	$97.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$97.80
Rate for Payer: LLUH Dept of Risk Management WC	$89.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$122.25

HC LAB REF CHROMOSOME INTERP & REPORT

Facility

$163.00

Service Code	CPT 88291 90
Hospital Charge Code	900910747
Hospital Revenue Code	310
Min. Negotiated Rate	$89.65
Max. Negotiated Rate	$130.40
Rate for Payer: Cash Price	$73.35
Rate for Payer: Cigna of CA HMO/PPO	$130.40
Rate for Payer: Health Smart Auto/Commercial	$97.80
Rate for Payer: LLUH Dept of Risk Management WC	$89.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$122.25

HC LAB REF CHROMOSOMES SCE

Facility

$566.00

Service Code	CPT 88291 90
Hospital Charge Code	900915261
Hospital Revenue Code	300
Min. Negotiated Rate	$311.30
Max. Negotiated Rate	$452.80
Rate for Payer: Cash Price	$254.70
Rate for Payer: Cigna of CA HMO/PPO	$452.80
Rate for Payer: Health Smart Auto/Commercial	$339.60
Rate for Payer: LLUH Dept of Risk Management WC	$311.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$424.50

HC LAB REF CHROMOSOMES SCE

Facility

$566.00

Service Code	CPT 88291 90
Hospital Charge Code	900915261
Hospital Revenue Code	300
Min. Negotiated Rate	$311.30
Max. Negotiated Rate	$424.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$339.60
Rate for Payer: Aetna of CA Government/Medicare	$339.60
Rate for Payer: Cash Price	$254.70
Rate for Payer: Health Smart Auto/Commercial	$339.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$339.60
Rate for Payer: LLUH Dept of Risk Management WC	$311.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$424.50

HC LAB REF CHROMOSOMES SCE

Facility

$566.00

Service Code	CPT 88291
Hospital Charge Code	900915261
Hospital Revenue Code	309
Min. Negotiated Rate	$311.30
Max. Negotiated Rate	$424.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$339.60
Rate for Payer: Aetna of CA Government/Medicare	$339.60
Rate for Payer: Cash Price	$254.70
Rate for Payer: Health Smart Auto/Commercial	$339.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$339.60
Rate for Payer: LLUH Dept of Risk Management WC	$311.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$424.50

HC LAB REF CHROMOSOMES SCE

Facility

$566.00

Service Code	CPT 88291
Hospital Charge Code	900915261
Hospital Revenue Code	309
Min. Negotiated Rate	$311.30
Max. Negotiated Rate	$452.80
Rate for Payer: Cash Price	$254.70
Rate for Payer: Cigna of CA HMO/PPO	$452.80
Rate for Payer: Health Smart Auto/Commercial	$339.60
Rate for Payer: LLUH Dept of Risk Management WC	$311.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$424.50

Know your out-of-pocket cost for care.

All Charges