Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC HEPATITIS B CORE AB IGM

Facility

$32.00

Service Code	CPT 86705
Hospital Charge Code	900913615
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 B CORE AB IGM

Facility

$22.00

Service Code	CPT 86705
Hospital Charge Code	900913615
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 IGM INDIVIDUAL

Facility

$291.00

Service Code	CPT 86705
Hospital Charge Code	900913618
Hospital Revenue Code	302
Min. Negotiated Rate	$160.05
Max. Negotiated Rate	$232.80
Rate for Payer: Cash Price	$130.95
Rate for Payer: Cigna of CA HMO/PPO	$232.80
Rate for Payer: Health Smart Auto/Commercial	$174.60
Rate for Payer: LLUH Dept of Risk Management WC	$160.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$218.25

HC HEPATITIS B CORE AB IGM INDIVIDUAL

Facility

$45.00

Service Code	CPT 86705
Hospital Charge Code	900913618
Hospital Revenue Code	302
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.00
Rate for Payer: Aetna of CA Government/Medicare	$27.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC HEPATITIS B CORE IGM

Facility

$45.00

Service Code	CPT 86705
Hospital Charge Code	900910958
Hospital Revenue Code	302
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.00
Rate for Payer: Aetna of CA Government/Medicare	$27.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC HEPATITIS B CORE IGM

Facility

$288.00

Service Code	CPT 86705
Hospital Charge Code	900910958
Hospital Revenue Code	302
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 HEPATITIS B CORE IGM INDIVIDUAL

Facility

$288.00

Service Code	CPT 86705
Hospital Charge Code	900912336
Hospital Revenue Code	302
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 HEPATITIS B CORE IGM INDIVIDUAL

Facility

$45.00

Service Code	CPT 86705
Hospital Charge Code	900912336
Hospital Revenue Code	302
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.00
Rate for Payer: Aetna of CA Government/Medicare	$27.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC HEPATITIS BE AB

Facility

$61.00

Service Code	CPT 87350
Hospital Charge Code	900913616
Hospital Revenue Code	302
Min. Negotiated Rate	$33.55
Max. Negotiated Rate	$48.80
Rate for Payer: Cash Price	$27.45
Rate for Payer: Cigna of CA HMO/PPO	$48.80
Rate for Payer: Health Smart Auto/Commercial	$36.60
Rate for Payer: LLUH Dept of Risk Management WC	$33.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.75

HC HEPATITIS BE AB

Facility

$44.00

Service Code	CPT 87350
Hospital Charge Code	900913616
Hospital Revenue Code	302
Min. Negotiated Rate	$24.20
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$26.40
Rate for Payer: Aetna of CA Government/Medicare	$26.40
Rate for Payer: Cash Price	$19.80
Rate for Payer: Health Smart Auto/Commercial	$26.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$26.40
Rate for Payer: LLUH Dept of Risk Management WC	$24.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.00

HC HEPATITIS B SURFACE AG

Facility

$36.00

Service Code	CPT 87340
Hospital Charge Code	900910831
Hospital Revenue Code	306
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$27.00
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: Health Smart Auto/Commercial	$21.60
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 Beech St/Commercial/PHCS	$27.00

HC HEPATITIS B SURFACE AG

Facility

$141.00

Service Code	CPT 87340
Hospital Charge Code	900910831
Hospital Revenue Code	306
Min. Negotiated Rate	$77.55
Max. Negotiated Rate	$112.80
Rate for Payer: Cash Price	$63.45
Rate for Payer: Cigna of CA HMO/PPO	$112.80
Rate for Payer: Health Smart Auto/Commercial	$84.60
Rate for Payer: LLUH Dept of Risk Management WC	$77.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$105.75

HC HEPATITIS B SURFACE AG (CONF)

Facility

$39.00

Service Code	CPT 87341
Hospital Charge Code	900910812
Hospital Revenue Code	306
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.40
Rate for Payer: Aetna of CA Government/Medicare	$23.40
Rate for Payer: Cash Price	$17.55
Rate for Payer: Health Smart Auto/Commercial	$23.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$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 B SURFACE AG (CONF)

Facility

$216.00

Service Code	CPT 87341
Hospital Charge Code	900910812
Hospital Revenue Code	306
Min. Negotiated Rate	$118.80
Max. Negotiated Rate	$172.80
Rate for Payer: Cash Price	$97.20
Rate for Payer: Cigna of CA HMO/PPO	$172.80
Rate for Payer: Health Smart Auto/Commercial	$129.60
Rate for Payer: LLUH Dept of Risk Management WC	$118.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$162.00

HC HEPATITIS B SURFACE AG INDIVIDUAL

Facility

$36.00

Service Code	CPT 87340
Hospital Charge Code	900912333
Hospital Revenue Code	306
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$27.00
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: Health Smart Auto/Commercial	$21.60
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 Beech St/Commercial/PHCS	$27.00

HC HEPATITIS B SURFACE AG INDIVIDUAL

Facility

$141.00

Service Code	CPT 87340
Hospital Charge Code	900912333
Hospital Revenue Code	306
Min. Negotiated Rate	$77.55
Max. Negotiated Rate	$112.80
Rate for Payer: Cash Price	$63.45
Rate for Payer: Cigna of CA HMO/PPO	$112.80
Rate for Payer: Health Smart Auto/Commercial	$84.60
Rate for Payer: LLUH Dept of Risk Management WC	$77.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$105.75

HC HEPATITIS B SURFACE ANTIBODY

Facility

$169.00

Service Code	CPT 86706
Hospital Charge Code	900910860
Hospital Revenue Code	302
Min. Negotiated Rate	$92.95
Max. Negotiated Rate	$135.20
Rate for Payer: Cash Price	$76.05
Rate for Payer: Cigna of CA HMO/PPO	$135.20
Rate for Payer: Health Smart Auto/Commercial	$101.40
Rate for Payer: LLUH Dept of Risk Management WC	$92.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$126.75

HC HEPATITIS B SURFACE ANTIBODY

Facility

$31.00

Service Code	CPT 86706
Hospital Charge Code	900910860
Hospital Revenue Code	302
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.60
Rate for Payer: Aetna of CA Government/Medicare	$18.60
Rate for Payer: Cash Price	$13.95
Rate for Payer: Health Smart Auto/Commercial	$18.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.60
Rate for Payer: LLUH Dept of Risk Management WC	$17.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$23.25

HC HEPATITIS C AB TOTAL

Facility

$53.00

Service Code	CPT 86803
Hospital Charge Code	900912155
Hospital Revenue Code	302
Min. Negotiated Rate	$29.15
Max. Negotiated Rate	$39.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$31.80
Rate for Payer: Aetna of CA Government/Medicare	$31.80
Rate for Payer: Cash Price	$23.85
Rate for Payer: Health Smart Auto/Commercial	$31.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$31.80
Rate for Payer: LLUH Dept of Risk Management WC	$29.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$39.75

HC HEPATITIS C AB TOTAL

Facility

$277.00

Service Code	CPT 86803
Hospital Charge Code	900912155
Hospital Revenue Code	302
Min. Negotiated Rate	$152.35
Max. Negotiated Rate	$221.60
Rate for Payer: Cash Price	$124.65
Rate for Payer: Cigna of CA HMO/PPO	$221.60
Rate for Payer: Health Smart Auto/Commercial	$166.20
Rate for Payer: LLUH Dept of Risk Management WC	$152.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$207.75

HC HEPATITIS C AB TOTAL INDIVIDUAL

Facility

$53.00

Service Code	CPT 86803
Hospital Charge Code	900912156
Hospital Revenue Code	302
Min. Negotiated Rate	$29.15
Max. Negotiated Rate	$39.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$31.80
Rate for Payer: Aetna of CA Government/Medicare	$31.80
Rate for Payer: Cash Price	$23.85
Rate for Payer: Health Smart Auto/Commercial	$31.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$31.80
Rate for Payer: LLUH Dept of Risk Management WC	$29.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$39.75

HC HEPATITIS C AB TOTAL INDIVIDUAL

Facility

$277.00

Service Code	CPT 86803
Hospital Charge Code	900912156
Hospital Revenue Code	302
Min. Negotiated Rate	$152.35
Max. Negotiated Rate	$221.60
Rate for Payer: Cash Price	$124.65
Rate for Payer: Cigna of CA HMO/PPO	$221.60
Rate for Payer: Health Smart Auto/Commercial	$166.20
Rate for Payer: LLUH Dept of Risk Management WC	$152.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$207.75

HC HERPES SIMPLEX TYPE 1

Facility

$58.00

Service Code	CPT 86695
Hospital Charge Code	900913660
Hospital Revenue Code	302
Min. Negotiated Rate	$31.90
Max. Negotiated Rate	$46.40
Rate for Payer: Cash Price	$26.10
Rate for Payer: Cigna of CA HMO/PPO	$46.40
Rate for Payer: Health Smart Auto/Commercial	$34.80
Rate for Payer: LLUH Dept of Risk Management WC	$31.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$43.50

HC HERPES SIMPLEX TYPE 1

Facility

$39.00

Service Code	CPT 86695
Hospital Charge Code	900913660
Hospital Revenue Code	302
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.40
Rate for Payer: Aetna of CA Government/Medicare	$23.40
Rate for Payer: Cash Price	$17.55
Rate for Payer: Health Smart Auto/Commercial	$23.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.40
Rate for Payer: LLUH Dept of Risk Management WC	$21.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.25

HC HERPES SIMPLEX TYPE 2

Facility

$39.00

Service Code	CPT 86696
Hospital Charge Code	900913661
Hospital Revenue Code	302
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.40
Rate for Payer: Aetna of CA Government/Medicare	$23.40
Rate for Payer: Cash Price	$17.55
Rate for Payer: Health Smart Auto/Commercial	$23.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.40
Rate for Payer: LLUH Dept of Risk Management WC	$21.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.25

Know your out-of-pocket cost for care.

All Charges