Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM FISH DIGEORGE VELO-CARDIO-FACL

Facility

$200.00

Service Code	CPT 88291
Hospital Charge Code	900910684
Hospital Revenue Code	310
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$150.00
Rate for Payer: Health Smart Auto/Commercial	$120.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$120.00
Rate for Payer: Aetna of CA Government/Medicare	$120.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$120.00
Rate for Payer: LLUH Dept of Risk Management WC	$110.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$150.00

HC SOM FISH FOR CLL

Facility

$350.00

Service Code	CPT 88291 90
Hospital Charge Code	900910707
Hospital Revenue Code	310
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$210.00
Rate for Payer: Aetna of CA Government/Medicare	$210.00
Rate for Payer: Cash Price	$157.50
Rate for Payer: Health Smart Auto/Commercial	$210.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$210.00
Rate for Payer: LLUH Dept of Risk Management WC	$192.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$262.50

HC SOM FISH FOR CLL

Facility

$350.00

Service Code	CPT 88291
Hospital Charge Code	900910707
Hospital Revenue Code	310
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$280.00
Rate for Payer: Cash Price	$157.50
Rate for Payer: Cigna of CA HMO/PPO	$280.00
Rate for Payer: Health Smart Auto/Commercial	$210.00
Rate for Payer: LLUH Dept of Risk Management WC	$192.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$262.50

HC SOM FISH FOR CLL

Facility

$350.00

Service Code	CPT 88291 90
Hospital Charge Code	900910707
Hospital Revenue Code	310
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$280.00
Rate for Payer: Cash Price	$157.50
Rate for Payer: Cigna of CA HMO/PPO	$280.00
Rate for Payer: Health Smart Auto/Commercial	$210.00
Rate for Payer: LLUH Dept of Risk Management WC	$192.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$262.50

HC SOM FISH FOR CLL

Facility

$350.00

Service Code	CPT 88291
Hospital Charge Code	900910707
Hospital Revenue Code	310
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$210.00
Rate for Payer: Aetna of CA Government/Medicare	$210.00
Rate for Payer: Cash Price	$157.50
Rate for Payer: Health Smart Auto/Commercial	$210.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$210.00
Rate for Payer: LLUH Dept of Risk Management WC	$192.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$262.50

HC SOM FISH MDS LOCUS ANOMALIES

Facility

$150.00

Service Code	CPT 88291
Hospital Charge Code	900912610
Hospital Revenue Code	310
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$120.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna of CA HMO/PPO	$120.00
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$112.50

HC SOM FISH MDS LOCUS ANOMALIES

Facility

$150.00

Service Code	CPT 88291 90
Hospital Charge Code	900912610
Hospital Revenue Code	310
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$120.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna of CA HMO/PPO	$120.00
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$112.50

HC SOM FISH MDS LOCUS ANOMALIES

Facility

$150.00

Service Code	CPT 88291
Hospital Charge Code	900912610
Hospital Revenue Code	310
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$90.00
Rate for Payer: Aetna of CA Government/Medicare	$90.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$112.50

HC SOM FISH MDS LOCUS ANOMALIES

Facility

$150.00

Service Code	CPT 88291 90
Hospital Charge Code	900912610
Hospital Revenue Code	310
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$90.00
Rate for Payer: Aetna of CA Government/Medicare	$90.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$112.50

HC SOM FISH NEWBORN ANEUPLOIDY DETECT

Facility

$200.00

Service Code	CPT 88291
Hospital Charge Code	900910685
Hospital Revenue Code	310
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$160.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cigna of CA HMO/PPO	$160.00
Rate for Payer: Health Smart Auto/Commercial	$120.00
Rate for Payer: LLUH Dept of Risk Management WC	$110.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$150.00

HC SOM FISH NEWBORN ANEUPLOIDY DETECT

Facility

$200.00

Service Code	CPT 88291 90
Hospital Charge Code	900910685
Hospital Revenue Code	310
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$120.00
Rate for Payer: Aetna of CA Government/Medicare	$120.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Smart Auto/Commercial	$120.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$120.00
Rate for Payer: LLUH Dept of Risk Management WC	$110.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$150.00

HC SOM FISH NEWBORN ANEUPLOIDY DETECT

Facility

$200.00

Service Code	CPT 88291
Hospital Charge Code	900910685
Hospital Revenue Code	310
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$120.00
Rate for Payer: Aetna of CA Government/Medicare	$120.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Smart Auto/Commercial	$120.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$120.00
Rate for Payer: LLUH Dept of Risk Management WC	$110.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$150.00

HC SOM FISH NEWBORN ANEUPLOIDY DETECT

Facility

$200.00

Service Code	CPT 88291 90
Hospital Charge Code	900910685
Hospital Revenue Code	310
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$160.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cigna of CA HMO/PPO	$160.00
Rate for Payer: Health Smart Auto/Commercial	$120.00
Rate for Payer: LLUH Dept of Risk Management WC	$110.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$150.00

HC SOM FISH PRENATAL ANEUPLOIDY DETEC

Facility

$225.00

Service Code	CPT 88291 90
Hospital Charge Code	900910689
Hospital Revenue Code	310
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$168.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$135.00
Rate for Payer: Aetna of CA Government/Medicare	$135.00
Rate for Payer: Cash Price	$101.25
Rate for Payer: Health Smart Auto/Commercial	$135.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$135.00
Rate for Payer: LLUH Dept of Risk Management WC	$123.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$168.75

HC SOM FISH PRENATAL ANEUPLOIDY DETEC

Facility

$225.00

Service Code	CPT 88291 90
Hospital Charge Code	900910689
Hospital Revenue Code	310
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$180.00
Rate for Payer: Cash Price	$101.25
Rate for Payer: Cigna of CA HMO/PPO	$180.00
Rate for Payer: Health Smart Auto/Commercial	$135.00
Rate for Payer: LLUH Dept of Risk Management WC	$123.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$168.75

HC SOM FISH PRENATAL ANEUPLOIDY DETEC

Facility

$225.00

Service Code	CPT 88291
Hospital Charge Code	900910689
Hospital Revenue Code	310
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$180.00
Rate for Payer: Cash Price	$101.25
Rate for Payer: Cigna of CA HMO/PPO	$180.00
Rate for Payer: Health Smart Auto/Commercial	$135.00
Rate for Payer: LLUH Dept of Risk Management WC	$123.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$168.75

HC SOM FISH PRENATAL ANEUPLOIDY DETEC

Facility

$225.00

Service Code	CPT 88291
Hospital Charge Code	900910689
Hospital Revenue Code	310
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$168.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$135.00
Rate for Payer: Aetna of CA Government/Medicare	$135.00
Rate for Payer: Cash Price	$101.25
Rate for Payer: Health Smart Auto/Commercial	$135.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$135.00
Rate for Payer: LLUH Dept of Risk Management WC	$123.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$168.75

HC SOM FISH UROTHELIAL CANCER

Facility

$440.00

Service Code	CPT 88120 TC
Hospital Charge Code	900910694
Hospital Revenue Code	310
Min. Negotiated Rate	$242.00
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$264.00
Rate for Payer: Aetna of CA Government/Medicare	$264.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Health Smart Auto/Commercial	$264.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$264.00
Rate for Payer: LLUH Dept of Risk Management WC	$242.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$330.00

HC SOM FISH UROTHELIAL CANCER

Facility

$440.00

Service Code	CPT 88120
Hospital Charge Code	900910694
Hospital Revenue Code	310
Min. Negotiated Rate	$242.00
Max. Negotiated Rate	$352.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cigna of CA HMO/PPO	$352.00
Rate for Payer: Health Smart Auto/Commercial	$264.00
Rate for Payer: LLUH Dept of Risk Management WC	$242.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$330.00

HC SOM FISH UROTHELIAL CANCER

Facility

$440.00

Service Code	CPT 88120
Hospital Charge Code	900910694
Hospital Revenue Code	310
Min. Negotiated Rate	$242.00
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$264.00
Rate for Payer: Aetna of CA Government/Medicare	$264.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Health Smart Auto/Commercial	$264.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$264.00
Rate for Payer: LLUH Dept of Risk Management WC	$242.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$330.00

HC SOM FISH UROTHELIAL CANCER

Facility

$440.00

Service Code	CPT 88120 TC
Hospital Charge Code	900910694
Hospital Revenue Code	310
Min. Negotiated Rate	$242.00
Max. Negotiated Rate	$352.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cigna of CA HMO/PPO	$352.00
Rate for Payer: Health Smart Auto/Commercial	$264.00
Rate for Payer: LLUH Dept of Risk Management WC	$242.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$330.00

HC SOM FLECAINIDE ACETATE

Facility

$50.00

Service Code	CPT 80181
Hospital Charge Code	900910551
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 SOM FLECAINIDE ACETATE

Facility

$50.00

Service Code	CPT 80181 90
Hospital Charge Code	900910551
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 SOM FLECAINIDE ACETATE

Facility

$50.00

Service Code	CPT 80181
Hospital Charge Code	900910551
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$40.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cigna of CA HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.50

HC SOM FLECAINIDE ACETATE

Facility

$50.00

Service Code	CPT 80181 90
Hospital Charge Code	900910551
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$40.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cigna of CA HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.50

Know your out-of-pocket cost for care.

All Charges