Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC HAPTOGLOBIN

Facility

$210.00

Service Code	CPT 83010
Hospital Charge Code	900910844
Hospital Revenue Code	301
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$168.00
Rate for Payer: Cash Price	$94.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$168.00
Rate for Payer: Health Smart Auto/Commercial	$126.00
Rate for Payer: LLUH Dept of Risk Management WC	$115.50
Rate for Payer: Multiplan Commercial	$157.50

HC HAPTOGLOBIN

Facility

$105.26

Service Code	CPT 83010
Hospital Charge Code	900910844
Hospital Revenue Code	301
Min. Negotiated Rate	$12.58
Max. Negotiated Rate	$84.21
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$63.16
Rate for Payer: Aetna of CA Government/Medicare	$63.16
Rate for Payer: Cash Price	$47.37
Rate for Payer: Cash Price	$47.37
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$84.21
Rate for Payer: Health Smart Auto/Commercial	$63.16
Rate for Payer: Intervalley Health Plan Commercial	$12.58
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$63.16
Rate for Payer: LLUH Dept of Risk Management WC	$57.89
Rate for Payer: Multiplan Commercial	$78.94

HC HCV RNA QUANT

Facility

$226.00

Service Code	CPT 87522
Hospital Charge Code	900913610
Hospital Revenue Code	306
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$180.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$135.60
Rate for Payer: Aetna of CA Government/Medicare	$135.60
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$180.80
Rate for Payer: Health Smart Auto/Commercial	$135.60
Rate for Payer: Intervalley Health Plan Commercial	$42.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$135.60
Rate for Payer: LLUH Dept of Risk Management WC	$124.30
Rate for Payer: Multiplan Commercial	$169.50

HC HCV RNA QUANT

Facility

$643.00

Service Code	CPT 87522
Hospital Charge Code	900913610
Hospital Revenue Code	306
Min. Negotiated Rate	$353.65
Max. Negotiated Rate	$514.40
Rate for Payer: Cash Price	$289.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$514.40
Rate for Payer: Health Smart Auto/Commercial	$385.80
Rate for Payer: LLUH Dept of Risk Management WC	$353.65
Rate for Payer: Multiplan Commercial	$482.25

HC HEMATOCRIT HCT POC

Facility

$133.00

Service Code	CPT 85014
Hospital Charge Code	900912115
Hospital Revenue Code	301
Min. Negotiated Rate	$73.15
Max. Negotiated Rate	$106.40
Rate for Payer: Cash Price	$59.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$106.40
Rate for Payer: Health Smart Auto/Commercial	$79.80
Rate for Payer: LLUH Dept of Risk Management WC	$73.15
Rate for Payer: Multiplan Commercial	$99.75

HC HEMATOCRIT HCT POC

Facility

$133.00

Service Code	CPT 85014
Hospital Charge Code	900912115
Hospital Revenue Code	301
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$106.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$79.80
Rate for Payer: Aetna of CA Government/Medicare	$79.80
Rate for Payer: Cash Price	$59.85
Rate for Payer: Cash Price	$59.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$106.40
Rate for Payer: Health Smart Auto/Commercial	$79.80
Rate for Payer: Intervalley Health Plan Commercial	$2.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$79.80
Rate for Payer: LLUH Dept of Risk Management WC	$73.15
Rate for Payer: Multiplan Commercial	$99.75

HC HEMECH-EPINEPHRINE

Facility

$445.00

Service Code	CPT 85576
Hospital Charge Code	900910197
Hospital Revenue Code	305
Min. Negotiated Rate	$244.75
Max. Negotiated Rate	$356.00
Rate for Payer: Cash Price	$200.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$356.00
Rate for Payer: Health Smart Auto/Commercial	$267.00
Rate for Payer: LLUH Dept of Risk Management WC	$244.75
Rate for Payer: Multiplan Commercial	$333.75

HC HEMECH-EPINEPHRINE

Facility

$156.00

Service Code	CPT 85576
Hospital Charge Code	900910197
Hospital Revenue Code	305
Min. Negotiated Rate	$24.91
Max. Negotiated Rate	$124.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$93.60
Rate for Payer: Aetna of CA Government/Medicare	$93.60
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cash Price	$70.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$124.80
Rate for Payer: Health Smart Auto/Commercial	$93.60
Rate for Payer: Intervalley Health Plan Commercial	$24.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$93.60
Rate for Payer: LLUH Dept of Risk Management WC	$85.80
Rate for Payer: Multiplan Commercial	$117.00

HC HEMECH SCRN-ARACHEDONIC ACID A

Facility

$370.00

Service Code	CPT 85576
Hospital Charge Code	900912002
Hospital Revenue Code	305
Min. Negotiated Rate	$203.50
Max. Negotiated Rate	$296.00
Rate for Payer: Cash Price	$166.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$296.00
Rate for Payer: Health Smart Auto/Commercial	$222.00
Rate for Payer: LLUH Dept of Risk Management WC	$203.50
Rate for Payer: Multiplan Commercial	$277.50

HC HEMECH SCRN-ARACHEDONIC ACID A

Facility

$156.00

Service Code	CPT 85576
Hospital Charge Code	900912002
Hospital Revenue Code	305
Min. Negotiated Rate	$24.91
Max. Negotiated Rate	$124.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$93.60
Rate for Payer: Aetna of CA Government/Medicare	$93.60
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cash Price	$70.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$124.80
Rate for Payer: Health Smart Auto/Commercial	$93.60
Rate for Payer: Intervalley Health Plan Commercial	$24.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$93.60
Rate for Payer: LLUH Dept of Risk Management WC	$85.80
Rate for Payer: Multiplan Commercial	$117.00

HC HEMODIALYSIS

Facility

$931.00

Service Code	CPT 90935
Hospital Charge Code	909902245
Hospital Revenue Code	821
Min. Negotiated Rate	$512.05
Max. Negotiated Rate	$744.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$558.60
Rate for Payer: Aetna of CA Government/Medicare	$558.60
Rate for Payer: Cash Price	$418.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$744.80
Rate for Payer: Health Smart Auto/Commercial	$558.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$558.60
Rate for Payer: LLUH Dept of Risk Management WC	$512.05
Rate for Payer: Multiplan Commercial	$698.25

HC HEMODIALYSIS

Facility

$931.00

Service Code	CPT 90935
Hospital Charge Code	909902245
Hospital Revenue Code	821
Min. Negotiated Rate	$512.05
Max. Negotiated Rate	$744.80
Rate for Payer: Cash Price	$418.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$744.80
Rate for Payer: Health Smart Auto/Commercial	$558.60
Rate for Payer: LLUH Dept of Risk Management WC	$512.05
Rate for Payer: Multiplan Commercial	$698.25

HC HEMOGLOBIN A1C

Facility

$81.80

Service Code	CPT 83036
Hospital Charge Code	900912128
Hospital Revenue Code	301
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$65.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$49.08
Rate for Payer: Aetna of CA Government/Medicare	$49.08
Rate for Payer: Cash Price	$36.81
Rate for Payer: Cash Price	$36.81
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$65.44
Rate for Payer: Health Smart Auto/Commercial	$49.08
Rate for Payer: Intervalley Health Plan Commercial	$9.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$49.08
Rate for Payer: LLUH Dept of Risk Management WC	$44.99
Rate for Payer: Multiplan Commercial	$61.35

HC HEMOGLOBIN A1C

Facility

$235.00

Service Code	CPT 83036
Hospital Charge Code	900912128
Hospital Revenue Code	301
Min. Negotiated Rate	$129.25
Max. Negotiated Rate	$188.00
Rate for Payer: Cash Price	$105.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$188.00
Rate for Payer: Health Smart Auto/Commercial	$141.00
Rate for Payer: LLUH Dept of Risk Management WC	$129.25
Rate for Payer: Multiplan Commercial	$176.25

HC HEMOGLOBIN A1C (POC)

Facility

$235.00

Service Code	CPT 83036
Hospital Charge Code	900912157
Hospital Revenue Code	301
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$188.00
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: Cash Price	$105.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$188.00
Rate for Payer: Health Smart Auto/Commercial	$141.00
Rate for Payer: Intervalley Health Plan Commercial	$9.71
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 Commercial	$176.25

HC HEMOGLOBIN A1C (POC)

Facility

$235.00

Service Code	CPT 83036
Hospital Charge Code	900912157
Hospital Revenue Code	301
Min. Negotiated Rate	$129.25
Max. Negotiated Rate	$188.00
Rate for Payer: Cash Price	$105.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$188.00
Rate for Payer: Health Smart Auto/Commercial	$141.00
Rate for Payer: LLUH Dept of Risk Management WC	$129.25
Rate for Payer: Multiplan Commercial	$176.25

HC HEMOGLOBIN CITRATE

Facility

$112.00

Service Code	CPT 83020
Hospital Charge Code	900910898
Hospital Revenue Code	301
Min. Negotiated Rate	$61.60
Max. Negotiated Rate	$89.60
Rate for Payer: Cash Price	$50.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$89.60
Rate for Payer: Health Smart Auto/Commercial	$67.20
Rate for Payer: LLUH Dept of Risk Management WC	$61.60
Rate for Payer: Multiplan Commercial	$84.00

HC HEMOGLOBIN CITRATE

Facility

$67.99

Service Code	CPT 83020
Hospital Charge Code	900910898
Hospital Revenue Code	301
Min. Negotiated Rate	$12.87
Max. Negotiated Rate	$54.39
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$40.79
Rate for Payer: Aetna of CA Government/Medicare	$40.79
Rate for Payer: Cash Price	$30.60
Rate for Payer: Cash Price	$30.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$54.39
Rate for Payer: Health Smart Auto/Commercial	$40.79
Rate for Payer: Intervalley Health Plan Commercial	$12.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$40.79
Rate for Payer: LLUH Dept of Risk Management WC	$37.39
Rate for Payer: Multiplan Commercial	$50.99

HC HEMOGLOBIN ELECTROPHORESIS

Facility

$67.99

Service Code	CPT 83020
Hospital Charge Code	900910897
Hospital Revenue Code	301
Min. Negotiated Rate	$12.87
Max. Negotiated Rate	$54.39
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$40.79
Rate for Payer: Aetna of CA Government/Medicare	$40.79
Rate for Payer: Cash Price	$30.60
Rate for Payer: Cash Price	$30.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$54.39
Rate for Payer: Health Smart Auto/Commercial	$40.79
Rate for Payer: Intervalley Health Plan Commercial	$12.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$40.79
Rate for Payer: LLUH Dept of Risk Management WC	$37.39
Rate for Payer: Multiplan Commercial	$50.99

HC HEMOGLOBIN ELECTROPHORESIS

Facility

$112.00

Service Code	CPT 83020
Hospital Charge Code	900910897
Hospital Revenue Code	301
Min. Negotiated Rate	$61.60
Max. Negotiated Rate	$89.60
Rate for Payer: Cash Price	$50.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$89.60
Rate for Payer: Health Smart Auto/Commercial	$67.20
Rate for Payer: LLUH Dept of Risk Management WC	$61.60
Rate for Payer: Multiplan Commercial	$84.00

HC HEMOGLOBIN FETAL, STAIN

Facility

$481.00

Service Code	CPT 85460
Hospital Charge Code	900910133
Hospital Revenue Code	305
Min. Negotiated Rate	$264.55
Max. Negotiated Rate	$384.80
Rate for Payer: Cash Price	$216.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$384.80
Rate for Payer: Health Smart Auto/Commercial	$288.60
Rate for Payer: LLUH Dept of Risk Management WC	$264.55
Rate for Payer: Multiplan Commercial	$360.75

HC HEMOGLOBIN FETAL, STAIN

Facility

$28.00

Service Code	CPT 85460
Hospital Charge Code	900910133
Hospital Revenue Code	305
Min. Negotiated Rate	$7.73
Max. Negotiated Rate	$22.40
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: Cash Price	$12.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.40
Rate for Payer: Health Smart Auto/Commercial	$16.80
Rate for Payer: Intervalley Health Plan Commercial	$7.73
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 Commercial	$21.00

HC HEMOGLOBIN PLASMA

Facility

$154.00

Service Code	CPT 83051
Hospital Charge Code	900912162
Hospital Revenue Code	301
Min. Negotiated Rate	$84.70
Max. Negotiated Rate	$123.20
Rate for Payer: Cash Price	$69.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$123.20
Rate for Payer: Health Smart Auto/Commercial	$92.40
Rate for Payer: LLUH Dept of Risk Management WC	$84.70
Rate for Payer: Multiplan Commercial	$115.50

HC HEMOGLOBIN PLASMA

Facility

$36.00

Service Code	CPT 83051
Hospital Charge Code	900912162
Hospital Revenue Code	301
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.60
Rate for Payer: Aetna of CA Government/Medicare	$21.60
Rate for Payer: Cash Price	$16.20
Rate for Payer: Cash Price	$16.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$28.80
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: Intervalley Health Plan Commercial	$7.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Commercial	$27.00

HC HEMOGLOBIN (POC)

Facility

$95.00

Service Code	CPT 85018
Hospital Charge Code	900912023
Hospital Revenue Code	305
Min. Negotiated Rate	$52.25
Max. Negotiated Rate	$76.00
Rate for Payer: Cash Price	$42.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$76.00
Rate for Payer: Health Smart Auto/Commercial	$57.00
Rate for Payer: LLUH Dept of Risk Management WC	$52.25
Rate for Payer: Multiplan Commercial	$71.25

Know your out-of-pocket cost for care.

All Charges