Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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

HC HEPARIN NEUTRALIZED PT/PTT

Facility

$34.00

Service Code	CPT 85525
Hospital Charge Code	900910094
Hospital Revenue Code	305
Min. Negotiated Rate	$11.84
Max. Negotiated Rate	$27.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.40
Rate for Payer: Aetna of CA Government/Medicare	$20.40
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cash Price	$15.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$27.20
Rate for Payer: Health Smart Auto/Commercial	$20.40
Rate for Payer: Intervalley Health Plan Commercial	$11.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.40
Rate for Payer: LLUH Dept of Risk Management WC	$18.70
Rate for Payer: Multiplan Commercial	$25.50

HC HEPARIN NEUTRALIZED PT/PTT

Facility

$194.00

Service Code	CPT 85525
Hospital Charge Code	900910094
Hospital Revenue Code	305
Min. Negotiated Rate	$106.70
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$87.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$155.20
Rate for Payer: Health Smart Auto/Commercial	$116.40
Rate for Payer: LLUH Dept of Risk Management WC	$106.70
Rate for Payer: Multiplan Commercial	$145.50

HC HEPATIC FUNCTION PANEL

Facility

$403.00

Service Code	CPT 80076
Hospital Charge Code	900912166
Hospital Revenue Code	301
Min. Negotiated Rate	$221.65
Max. Negotiated Rate	$322.40
Rate for Payer: Cash Price	$181.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$322.40
Rate for Payer: Health Smart Auto/Commercial	$241.80
Rate for Payer: LLUH Dept of Risk Management WC	$221.65
Rate for Payer: Multiplan Commercial	$302.25

HC HEPATIC FUNCTION PANEL

Facility

$64.81

Service Code	CPT 80076
Hospital Charge Code	900912166
Hospital Revenue Code	301
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$51.85
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$38.89
Rate for Payer: Aetna of CA Government/Medicare	$38.89
Rate for Payer: Cash Price	$29.16
Rate for Payer: Cash Price	$29.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$51.85
Rate for Payer: Health Smart Auto/Commercial	$38.89
Rate for Payer: Intervalley Health Plan Commercial	$8.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$38.89
Rate for Payer: LLUH Dept of Risk Management WC	$35.65
Rate for Payer: Multiplan Commercial	$48.61

HC HEPATITIS A AB IGM

Facility

$76.00

Service Code	CPT 86709
Hospital Charge Code	900913613
Hospital Revenue Code	302
Min. Negotiated Rate	$11.26
Max. Negotiated Rate	$60.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$45.60
Rate for Payer: Aetna of CA Government/Medicare	$45.60
Rate for Payer: Cash Price	$34.20
Rate for Payer: Cash Price	$34.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$60.80
Rate for Payer: Health Smart Auto/Commercial	$45.60
Rate for Payer: Intervalley Health Plan Commercial	$11.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$45.60
Rate for Payer: LLUH Dept of Risk Management WC	$41.80
Rate for Payer: Multiplan Commercial	$57.00

HC HEPATITIS A AB IGM

Facility

$90.00

Service Code	CPT 86709
Hospital Charge Code	900913613
Hospital Revenue Code	302
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$72.00
Rate for Payer: Cash Price	$40.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$72.00
Rate for Payer: Health Smart Auto/Commercial	$54.00
Rate for Payer: LLUH Dept of Risk Management WC	$49.50
Rate for Payer: Multiplan Commercial	$67.50

HC HEPATITIS A AB IGM INDIVIDUAL

Facility

$350.00

Service Code	CPT 86709
Hospital Charge Code	900913617
Hospital Revenue Code	302
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$280.00
Rate for Payer: Cash Price	$157.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$262.50

HC HEPATITIS A AB IGM INDIVIDUAL

Facility

$98.00

Service Code	CPT 86709
Hospital Charge Code	900913617
Hospital Revenue Code	302
Min. Negotiated Rate	$11.26
Max. Negotiated Rate	$78.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$58.80
Rate for Payer: Aetna of CA Government/Medicare	$58.80
Rate for Payer: Cash Price	$44.10
Rate for Payer: Cash Price	$44.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$78.40
Rate for Payer: Health Smart Auto/Commercial	$58.80
Rate for Payer: Intervalley Health Plan Commercial	$11.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$58.80
Rate for Payer: LLUH Dept of Risk Management WC	$53.90
Rate for Payer: Multiplan Commercial	$73.50

HC HEPATITIS A AB TOTAL

Facility

$64.00

Service Code	CPT 86708
Hospital Charge Code	900913612
Hospital Revenue Code	302
Min. Negotiated Rate	$12.39
Max. Negotiated Rate	$51.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$38.40
Rate for Payer: Aetna of CA Government/Medicare	$38.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$51.20
Rate for Payer: Health Smart Auto/Commercial	$38.40
Rate for Payer: Intervalley Health Plan Commercial	$12.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$38.40
Rate for Payer: LLUH Dept of Risk Management WC	$35.20
Rate for Payer: Multiplan Commercial	$48.00

HC HEPATITIS A AB TOTAL

Facility

$74.00

Service Code	CPT 86708
Hospital Charge Code	900913612
Hospital Revenue Code	302
Min. Negotiated Rate	$40.70
Max. Negotiated Rate	$59.20
Rate for Payer: Cash Price	$33.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$59.20
Rate for Payer: Health Smart Auto/Commercial	$44.40
Rate for Payer: LLUH Dept of Risk Management WC	$40.70
Rate for Payer: Multiplan Commercial	$55.50

HC HEPATITIS B CORE AB

Facility

$95.86

Service Code	CPT 86704
Hospital Charge Code	900913614
Hospital Revenue Code	302
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$76.69
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$57.52
Rate for Payer: Aetna of CA Government/Medicare	$57.52
Rate for Payer: Cash Price	$43.14
Rate for Payer: Cash Price	$43.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$76.69
Rate for Payer: Health Smart Auto/Commercial	$57.52
Rate for Payer: Intervalley Health Plan Commercial	$12.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$57.52
Rate for Payer: LLUH Dept of Risk Management WC	$52.72
Rate for Payer: Multiplan Commercial	$71.89

HC HEPATITIS B CORE AB

Facility

$106.51

Service Code	CPT 86704
Hospital Charge Code	900913614
Hospital Revenue Code	302
Min. Negotiated Rate	$58.58
Max. Negotiated Rate	$85.21
Rate for Payer: Cash Price	$47.93
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$85.21
Rate for Payer: Health Smart Auto/Commercial	$63.91
Rate for Payer: LLUH Dept of Risk Management WC	$58.58
Rate for Payer: Multiplan Commercial	$79.88

HC HEPATITIS B CORE AB IGM

Facility

$64.00

Service Code	CPT 86705
Hospital Charge Code	900913615
Hospital Revenue Code	302
Min. Negotiated Rate	$11.77
Max. Negotiated Rate	$51.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$38.40
Rate for Payer: Aetna of CA Government/Medicare	$38.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$51.20
Rate for Payer: Health Smart Auto/Commercial	$38.40
Rate for Payer: Intervalley Health Plan Commercial	$11.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$38.40
Rate for Payer: LLUH Dept of Risk Management WC	$35.20
Rate for Payer: Multiplan Commercial	$48.00

HC HEPATITIS B CORE AB IGM

Facility

$74.00

Service Code	CPT 86705
Hospital Charge Code	900913615
Hospital Revenue Code	302
Min. Negotiated Rate	$40.70
Max. Negotiated Rate	$59.20
Rate for Payer: Cash Price	$33.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$59.20
Rate for Payer: Health Smart Auto/Commercial	$44.40
Rate for Payer: LLUH Dept of Risk Management WC	$40.70
Rate for Payer: Multiplan Commercial	$55.50

HC HEPATITIS B CORE AB IGM INDIVIDUAL

Facility

$110.00

Service Code	CPT 86705
Hospital Charge Code	900913618
Hospital Revenue Code	302
Min. Negotiated Rate	$11.77
Max. Negotiated Rate	$88.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$66.00
Rate for Payer: Aetna of CA Government/Medicare	$66.00
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$88.00
Rate for Payer: Health Smart Auto/Commercial	$66.00
Rate for Payer: Intervalley Health Plan Commercial	$11.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$66.00
Rate for Payer: LLUH Dept of Risk Management WC	$60.50
Rate for Payer: Multiplan Commercial	$82.50

HC HEPATITIS B CORE AB IGM INDIVIDUAL

Facility

$335.00

Service Code	CPT 86705
Hospital Charge Code	900913618
Hospital Revenue Code	302
Min. Negotiated Rate	$184.25
Max. Negotiated Rate	$268.00
Rate for Payer: Cash Price	$150.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$268.00
Rate for Payer: Health Smart Auto/Commercial	$201.00
Rate for Payer: LLUH Dept of Risk Management WC	$184.25
Rate for Payer: Multiplan Commercial	$251.25

HC HEPATITIS B CORE IGM

Facility

$331.00

Service Code	CPT 86705
Hospital Charge Code	900910958
Hospital Revenue Code	302
Min. Negotiated Rate	$182.05
Max. Negotiated Rate	$264.80
Rate for Payer: Cash Price	$148.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$264.80
Rate for Payer: Health Smart Auto/Commercial	$198.60
Rate for Payer: LLUH Dept of Risk Management WC	$182.05
Rate for Payer: Multiplan Commercial	$248.25

HC HEPATITIS B CORE IGM

Facility

$110.00

Service Code	CPT 86705
Hospital Charge Code	900910958
Hospital Revenue Code	302
Min. Negotiated Rate	$11.77
Max. Negotiated Rate	$88.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$66.00
Rate for Payer: Aetna of CA Government/Medicare	$66.00
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$88.00
Rate for Payer: Health Smart Auto/Commercial	$66.00
Rate for Payer: Intervalley Health Plan Commercial	$11.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$66.00
Rate for Payer: LLUH Dept of Risk Management WC	$60.50
Rate for Payer: Multiplan Commercial	$82.50

HC HEPATITIS B CORE IGM INDIVIDUAL

Facility

$331.00

Service Code	CPT 86705
Hospital Charge Code	900912336
Hospital Revenue Code	302
Min. Negotiated Rate	$182.05
Max. Negotiated Rate	$264.80
Rate for Payer: Cash Price	$148.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$264.80
Rate for Payer: Health Smart Auto/Commercial	$198.60
Rate for Payer: LLUH Dept of Risk Management WC	$182.05
Rate for Payer: Multiplan Commercial	$248.25

HC HEPATITIS B CORE IGM INDIVIDUAL

Facility

$110.00

Service Code	CPT 86705
Hospital Charge Code	900912336
Hospital Revenue Code	302
Min. Negotiated Rate	$11.77
Max. Negotiated Rate	$88.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$66.00
Rate for Payer: Aetna of CA Government/Medicare	$66.00
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$88.00
Rate for Payer: Health Smart Auto/Commercial	$66.00
Rate for Payer: Intervalley Health Plan Commercial	$11.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$66.00
Rate for Payer: LLUH Dept of Risk Management WC	$60.50
Rate for Payer: Multiplan Commercial	$82.50

HC HEPATITIS BE AB

Facility

$46.00

Service Code	CPT 87350
Hospital Charge Code	900913616
Hospital Revenue Code	302
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$36.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.60
Rate for Payer: Aetna of CA Government/Medicare	$27.60
Rate for Payer: Cash Price	$20.70
Rate for Payer: Cash Price	$20.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$36.80
Rate for Payer: Health Smart Auto/Commercial	$27.60
Rate for Payer: Intervalley Health Plan Commercial	$11.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.60
Rate for Payer: LLUH Dept of Risk Management WC	$25.30
Rate for Payer: Multiplan Commercial	$34.50

HC HEPATITIS BE AB

Facility

$60.00

Service Code	CPT 87350
Hospital Charge Code	900913616
Hospital Revenue Code	302
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$48.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$48.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Commercial	$45.00

HC HEPATITIS B SURFACE AG

Facility

$138.00

Service Code	CPT 87340
Hospital Charge Code	900910831
Hospital Revenue Code	306
Min. Negotiated Rate	$75.90
Max. Negotiated Rate	$110.40
Rate for Payer: Cash Price	$62.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$110.40
Rate for Payer: Health Smart Auto/Commercial	$82.80
Rate for Payer: LLUH Dept of Risk Management WC	$75.90
Rate for Payer: Multiplan Commercial	$103.50

HC HEPATITIS B SURFACE AG

Facility

$93.34

Service Code	CPT 87340
Hospital Charge Code	900910831
Hospital Revenue Code	306
Min. Negotiated Rate	$10.33
Max. Negotiated Rate	$74.67
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$56.00
Rate for Payer: Aetna of CA Government/Medicare	$56.00
Rate for Payer: Cash Price	$42.00
Rate for Payer: Cash Price	$42.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$74.67
Rate for Payer: Health Smart Auto/Commercial	$56.00
Rate for Payer: Intervalley Health Plan Commercial	$10.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$56.00
Rate for Payer: LLUH Dept of Risk Management WC	$51.34
Rate for Payer: Multiplan Commercial	$70.00

Know your out-of-pocket cost for care.

All Charges