Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC HEMOGLOBIN A1C

Facility

$212.00

Service Code	CPT 83036
Hospital Charge Code	900912128
Hospital Revenue Code	301
Min. Negotiated Rate	$116.60
Max. Negotiated Rate	$169.60
Rate for Payer: Cash Price	$95.40
Rate for Payer: Cigna of CA HMO/PPO	$169.60
Rate for Payer: Health Smart Auto/Commercial	$127.20
Rate for Payer: LLUH Dept of Risk Management WC	$116.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$159.00

HC HEMOGLOBIN A1C (POC)

Facility

$212.00

Service Code	CPT 83036
Hospital Charge Code	900912157
Hospital Revenue Code	301
Min. Negotiated Rate	$116.60
Max. Negotiated Rate	$169.60
Rate for Payer: Cash Price	$95.40
Rate for Payer: Cigna of CA HMO/PPO	$169.60
Rate for Payer: Health Smart Auto/Commercial	$127.20
Rate for Payer: LLUH Dept of Risk Management WC	$116.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$159.00

HC HEMOGLOBIN A1C (POC)

Facility

$212.00

Service Code	CPT 83036
Hospital Charge Code	900912157
Hospital Revenue Code	301
Min. Negotiated Rate	$116.60
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$127.20
Rate for Payer: Aetna of CA Government/Medicare	$127.20
Rate for Payer: Cash Price	$95.40
Rate for Payer: Health Smart Auto/Commercial	$127.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$127.20
Rate for Payer: LLUH Dept of Risk Management WC	$116.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$159.00

HC HEMOGLOBIN CITRATE

Facility

$414.00

Service Code	CPT 83020
Hospital Charge Code	900910898
Hospital Revenue Code	301
Min. Negotiated Rate	$227.70
Max. Negotiated Rate	$331.20
Rate for Payer: Cash Price	$186.30
Rate for Payer: Cigna of CA HMO/PPO	$331.20
Rate for Payer: Health Smart Auto/Commercial	$248.40
Rate for Payer: LLUH Dept of Risk Management WC	$227.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$310.50

HC HEMOGLOBIN CITRATE

Facility

$38.00

Service Code	CPT 83020
Hospital Charge Code	900910898
Hospital Revenue Code	301
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$28.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.80
Rate for Payer: Aetna of CA Government/Medicare	$22.80
Rate for Payer: Cash Price	$17.10
Rate for Payer: Health Smart Auto/Commercial	$22.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.80
Rate for Payer: LLUH Dept of Risk Management WC	$20.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.50

HC HEMOGLOBIN ELECTROPHORESIS

Facility

$414.00

Service Code	CPT 83020
Hospital Charge Code	900910897
Hospital Revenue Code	301
Min. Negotiated Rate	$227.70
Max. Negotiated Rate	$331.20
Rate for Payer: Cash Price	$186.30
Rate for Payer: Cigna of CA HMO/PPO	$331.20
Rate for Payer: Health Smart Auto/Commercial	$248.40
Rate for Payer: LLUH Dept of Risk Management WC	$227.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$310.50

HC HEMOGLOBIN ELECTROPHORESIS

Facility

$38.00

Service Code	CPT 83020
Hospital Charge Code	900910897
Hospital Revenue Code	301
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$28.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.80
Rate for Payer: Aetna of CA Government/Medicare	$22.80
Rate for Payer: Cash Price	$17.10
Rate for Payer: Health Smart Auto/Commercial	$22.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.80
Rate for Payer: LLUH Dept of Risk Management WC	$20.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.50

HC HEMOGLOBIN FETAL, STAIN

Facility

$29.00

Service Code	CPT 85460
Hospital Charge Code	900910133
Hospital Revenue Code	305
Min. Negotiated Rate	$15.95
Max. Negotiated Rate	$21.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$17.40
Rate for Payer: Aetna of CA Government/Medicare	$17.40
Rate for Payer: Cash Price	$13.05
Rate for Payer: Health Smart Auto/Commercial	$17.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$17.40
Rate for Payer: LLUH Dept of Risk Management WC	$15.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21.75

HC HEMOGLOBIN FETAL, STAIN

Facility

$506.00

Service Code	CPT 85460
Hospital Charge Code	900910133
Hospital Revenue Code	305
Min. Negotiated Rate	$278.30
Max. Negotiated Rate	$404.80
Rate for Payer: Health Smart Auto/Commercial	$303.60
Rate for Payer: Cash Price	$227.70
Rate for Payer: Cigna of CA HMO/PPO	$404.80
Rate for Payer: LLUH Dept of Risk Management WC	$278.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$379.50

HC HEMOGLOBIN PLASMA

Facility

$26.00

Service Code	CPT 83051
Hospital Charge Code	900912162
Hospital Revenue Code	301
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$19.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.60
Rate for Payer: Aetna of CA Government/Medicare	$15.60
Rate for Payer: Cash Price	$11.70
Rate for Payer: Health Smart Auto/Commercial	$15.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.60
Rate for Payer: LLUH Dept of Risk Management WC	$14.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$19.50

HC HEMOGLOBIN PLASMA

Facility

$244.00

Service Code	CPT 83051
Hospital Charge Code	900912162
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 HEMOGLOBIN (POC)

Facility

$100.00

Service Code	CPT 85018
Hospital Charge Code	900912023
Hospital Revenue Code	305
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$80.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna of CA HMO/PPO	$80.00
Rate for Payer: Health Smart Auto/Commercial	$60.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$75.00

HC HEMOGLOBIN (POC)

Facility

$100.00

Service Code	CPT 85018
Hospital Charge Code	900912023
Hospital Revenue Code	305
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$60.00
Rate for Payer: Aetna of CA Government/Medicare	$60.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Smart Auto/Commercial	$60.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$60.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$75.00

HC HEPARIN NEUTRALIZED PT/PTT

Facility

$204.00

Service Code	CPT 85525
Hospital Charge Code	900910094
Hospital Revenue Code	305
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$163.20
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna of CA HMO/PPO	$163.20
Rate for Payer: Health Smart Auto/Commercial	$122.40
Rate for Payer: LLUH Dept of Risk Management WC	$112.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$153.00

HC HEPARIN NEUTRALIZED PT/PTT

Facility

$24.00

Service Code	CPT 85525
Hospital Charge Code	900910094
Hospital Revenue Code	305
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.40
Rate for Payer: Aetna of CA Government/Medicare	$14.40
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.00

HC HEPATIC FUNCTION PANEL

Facility

$19.00

Service Code	CPT 80076
Hospital Charge Code	900912166
Hospital Revenue Code	301
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$14.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.40
Rate for Payer: Aetna of CA Government/Medicare	$11.40
Rate for Payer: Cash Price	$8.55
Rate for Payer: Health Smart Auto/Commercial	$11.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.40
Rate for Payer: LLUH Dept of Risk Management WC	$10.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.25

HC HEPATIC FUNCTION PANEL

Facility

$431.00

Service Code	CPT 80076
Hospital Charge Code	900912166
Hospital Revenue Code	301
Min. Negotiated Rate	$237.05
Max. Negotiated Rate	$344.80
Rate for Payer: Cash Price	$193.95
Rate for Payer: Cigna of CA HMO/PPO	$344.80
Rate for Payer: Health Smart Auto/Commercial	$258.60
Rate for Payer: LLUH Dept of Risk Management WC	$237.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$323.25

HC HEPATITIS A AB IGM

Facility

$39.00

Service Code	CPT 86709
Hospital Charge Code	900913613
Hospital Revenue Code	302
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$31.20
Rate for Payer: Cash Price	$17.55
Rate for Payer: Cigna of CA HMO/PPO	$31.20
Rate for Payer: Health Smart Auto/Commercial	$23.40
Rate for Payer: LLUH Dept of Risk Management WC	$21.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.25

HC HEPATITIS A AB IGM

Facility

$28.00

Service Code	CPT 86709
Hospital Charge Code	900913613
Hospital Revenue Code	302
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 HEPATITIS A AB IGM INDIVIDUAL

Facility

$304.00

Service Code	CPT 86709
Hospital Charge Code	900913617
Hospital Revenue Code	302
Min. Negotiated Rate	$167.20
Max. Negotiated Rate	$243.20
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cigna of CA HMO/PPO	$243.20
Rate for Payer: Health Smart Auto/Commercial	$182.40
Rate for Payer: LLUH Dept of Risk Management WC	$167.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$228.00

HC HEPATITIS A AB IGM INDIVIDUAL

Facility

$43.00

Service Code	CPT 86709
Hospital Charge Code	900913617
Hospital Revenue Code	302
Min. Negotiated Rate	$23.65
Max. Negotiated Rate	$32.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$25.80
Rate for Payer: Aetna of CA Government/Medicare	$25.80
Rate for Payer: Cash Price	$19.35
Rate for Payer: Health Smart Auto/Commercial	$25.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$25.80
Rate for Payer: LLUH Dept of Risk Management WC	$23.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$32.25

HC HEPATITIS A AB TOTAL

Facility

$32.00

Service Code	CPT 86708
Hospital Charge Code	900913612
Hospital Revenue Code	302
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$25.60
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna of CA HMO/PPO	$25.60
Rate for Payer: Health Smart Auto/Commercial	$19.20
Rate for Payer: LLUH Dept of Risk Management WC	$17.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.00

HC HEPATITIS A AB TOTAL

Facility

$22.00

Service Code	CPT 86708
Hospital Charge Code	900913612
Hospital Revenue Code	302
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.20
Rate for Payer: Aetna of CA Government/Medicare	$13.20
Rate for Payer: Cash Price	$9.90
Rate for Payer: Health Smart Auto/Commercial	$13.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.20
Rate for Payer: LLUH Dept of Risk Management WC	$12.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.50

HC HEPATITIS B CORE AB

Facility

$23.00

Service Code	CPT 86704
Hospital Charge Code	900913614
Hospital Revenue Code	302
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$18.40
Rate for Payer: Cash Price	$10.35
Rate for Payer: Cigna of CA HMO/PPO	$18.40
Rate for Payer: Health Smart Auto/Commercial	$13.80
Rate for Payer: LLUH Dept of Risk Management WC	$12.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.25

HC HEPATITIS B CORE AB

Facility

$17.00

Service Code	CPT 86704
Hospital Charge Code	900913614
Hospital Revenue Code	302
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$12.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.20
Rate for Payer: Aetna of CA Government/Medicare	$10.20
Rate for Payer: Cash Price	$7.65
Rate for Payer: Health Smart Auto/Commercial	$10.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.20
Rate for Payer: LLUH Dept of Risk Management WC	$9.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.75

Know your out-of-pocket cost for care.

All Charges