Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

ESLICARBAZEPINE 800 MG TABLET [204959]

Facility

$29.10

Service Code	NDC 68180-293-06
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$16.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$23.28
Rate for Payer: Health Smart Auto/Commercial	$17.46
Rate for Payer: LLUH Dept of Risk Management WC	$16.00
Rate for Payer: Multiplan Commercial	$21.82

ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION [9957]

Facility

$0.53

Service Code	HCPCS J1805
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.42
Rate for Payer: Cash Price	$0.29
Rate for Payer: Cash Price	$0.46
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.67
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.42
Rate for Payer: Health Smart Auto/Commercial	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.50
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.46
Rate for Payer: Multiplan Commercial	$0.63
Rate for Payer: Multiplan Commercial	$0.40

ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION [9957]

Facility

$0.84

Service Code	HCPCS J1805
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.67
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.32
Rate for Payer: Aetna of CA Government/Medicare	$0.50
Rate for Payer: Aetna of CA Government/Medicare	$0.32
Rate for Payer: Cash Price	$0.29
Rate for Payer: Cash Price	$0.46
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.42
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.67
Rate for Payer: Health Smart Auto/Commercial	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.32
Rate for Payer: LLUH Dept of Risk Management WC	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.46
Rate for Payer: Multiplan Commercial	$0.40
Rate for Payer: Multiplan Commercial	$0.63

ESMOLOL 2,000 MG/100 ML (20 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [35639]

Facility

$1.80

Service Code	HCPCS J1805
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$1.44
Rate for Payer: Cash Price	$0.99
Rate for Payer: Cash Price	$1.06
Rate for Payer: Cash Price	$3.33
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.84
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.54
Rate for Payer: Health Smart Auto/Commercial	$1.08
Rate for Payer: Health Smart Auto/Commercial	$1.15
Rate for Payer: Health Smart Auto/Commercial	$3.63
Rate for Payer: LLUH Dept of Risk Management WC	$0.99
Rate for Payer: LLUH Dept of Risk Management WC	$1.06
Rate for Payer: LLUH Dept of Risk Management WC	$3.33
Rate for Payer: Multiplan Commercial	$1.35
Rate for Payer: Multiplan Commercial	$4.54
Rate for Payer: Multiplan Commercial	$1.44

ESMOLOL 2,000 MG/100 ML (20 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [35639]

Facility

$1.92

Service Code	HCPCS J1805
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.63
Rate for Payer: Aetna of CA Government/Medicare	$1.08
Rate for Payer: Aetna of CA Government/Medicare	$3.63
Rate for Payer: Aetna of CA Government/Medicare	$1.15
Rate for Payer: Cash Price	$3.33
Rate for Payer: Cash Price	$0.99
Rate for Payer: Cash Price	$1.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.54
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.84
Rate for Payer: Health Smart Auto/Commercial	$3.63
Rate for Payer: Health Smart Auto/Commercial	$1.15
Rate for Payer: Health Smart Auto/Commercial	$1.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.15
Rate for Payer: LLUH Dept of Risk Management WC	$1.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.99
Rate for Payer: LLUH Dept of Risk Management WC	$3.33
Rate for Payer: Multiplan Commercial	$1.35
Rate for Payer: Multiplan Commercial	$4.54
Rate for Payer: Multiplan Commercial	$1.44

ESMOLOL 2,000 MG/100 ML (20 MG/ML) IN STERILE WATER INTRAVENOUS SOLN [221109]

Facility

$1.55

Service Code	HCPCS J1806
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.24
Rate for Payer: Cash Price	$0.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.24
Rate for Payer: Health Smart Auto/Commercial	$0.93
Rate for Payer: LLUH Dept of Risk Management WC	$0.85
Rate for Payer: Multiplan Commercial	$1.16

ESMOLOL 2,000 MG/100 ML (20 MG/ML) IN STERILE WATER INTRAVENOUS SOLN [221109]

Facility

$1.55

Service Code	HCPCS J1806
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.93
Rate for Payer: Aetna of CA Government/Medicare	$0.93
Rate for Payer: Cash Price	$0.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.24
Rate for Payer: Health Smart Auto/Commercial	$0.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.93
Rate for Payer: LLUH Dept of Risk Management WC	$0.85
Rate for Payer: Multiplan Commercial	$1.16

ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [29805]

Facility

$0.62

Service Code	HCPCS J1805
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.50
Rate for Payer: Cash Price	$0.34
Rate for Payer: Cash Price	$0.85
Rate for Payer: Cash Price	$0.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.63
Rate for Payer: Health Smart Auto/Commercial	$0.93
Rate for Payer: Health Smart Auto/Commercial	$0.47
Rate for Payer: Health Smart Auto/Commercial	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.85
Rate for Payer: LLUH Dept of Risk Management WC	$0.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.43
Rate for Payer: Multiplan Commercial	$1.16
Rate for Payer: Multiplan Commercial	$0.59
Rate for Payer: Multiplan Commercial	$0.47

ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [29805]

Facility

$1.55

Service Code	HCPCS J1805
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.93
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.47
Rate for Payer: Aetna of CA Government/Medicare	$0.37
Rate for Payer: Aetna of CA Government/Medicare	$0.47
Rate for Payer: Aetna of CA Government/Medicare	$0.93
Rate for Payer: Cash Price	$0.44
Rate for Payer: Cash Price	$0.34
Rate for Payer: Cash Price	$0.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.63
Rate for Payer: Health Smart Auto/Commercial	$0.93
Rate for Payer: Health Smart Auto/Commercial	$0.47
Rate for Payer: Health Smart Auto/Commercial	$0.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.37
Rate for Payer: LLUH Dept of Risk Management WC	$0.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.85
Rate for Payer: Multiplan Commercial	$0.59
Rate for Payer: Multiplan Commercial	$0.47
Rate for Payer: Multiplan Commercial	$1.16

ESOMEPRAZOLE MAGNESIUM 20 MG CAPSULE,DELAYED RELEASE [29745]

Facility

$11.01

Service Code	NDC 0186-5020-54
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.06
Max. Negotiated Rate	$8.81
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.61
Rate for Payer: Aetna of CA Government/Medicare	$6.61
Rate for Payer: Cash Price	$6.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.81
Rate for Payer: Health Smart Auto/Commercial	$6.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.61
Rate for Payer: LLUH Dept of Risk Management WC	$6.06
Rate for Payer: Multiplan Commercial	$8.26

ESOMEPRAZOLE MAGNESIUM 20 MG CAPSULE,DELAYED RELEASE [29745]

Facility

$11.01

Service Code	NDC 0186-5020-54
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.06
Max. Negotiated Rate	$8.81
Rate for Payer: Cash Price	$6.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.81
Rate for Payer: Health Smart Auto/Commercial	$6.61
Rate for Payer: LLUH Dept of Risk Management WC	$6.06
Rate for Payer: Multiplan Commercial	$8.26

ESOMEPRAZOLE MAGNESIUM 40 MG CAPSULE,DELAYED RELEASE [29746]

Facility

$11.01

Service Code	NDC 0186-5040-54
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.06
Max. Negotiated Rate	$8.81
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.61
Rate for Payer: Aetna of CA Government/Medicare	$6.61
Rate for Payer: Cash Price	$6.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.81
Rate for Payer: Health Smart Auto/Commercial	$6.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.61
Rate for Payer: LLUH Dept of Risk Management WC	$6.06
Rate for Payer: Multiplan Commercial	$8.26

ESOMEPRAZOLE MAGNESIUM 40 MG CAPSULE,DELAYED RELEASE [29746]

Facility

$11.01

Service Code	NDC 0186-5040-54
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.06
Max. Negotiated Rate	$8.81
Rate for Payer: Cash Price	$6.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.81
Rate for Payer: Health Smart Auto/Commercial	$6.61
Rate for Payer: LLUH Dept of Risk Management WC	$6.06
Rate for Payer: Multiplan Commercial	$8.26

ESOMEPRAZOLE MAGNESIUM DR 10 MG GRANULES DELAYED RELEASE FOR SUSP [91031]

Facility

$11.49

Service Code	NDC 0186-4010-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$9.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.89
Rate for Payer: Aetna of CA Government/Medicare	$6.89
Rate for Payer: Cash Price	$6.32
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$9.19
Rate for Payer: Health Smart Auto/Commercial	$6.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.89
Rate for Payer: LLUH Dept of Risk Management WC	$6.32
Rate for Payer: Multiplan Commercial	$8.62

ESOMEPRAZOLE MAGNESIUM DR 10 MG GRANULES DELAYED RELEASE FOR SUSP [91031]

Facility

$11.49

Service Code	NDC 0186-4010-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$9.19
Rate for Payer: Cash Price	$6.32
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$9.19
Rate for Payer: Health Smart Auto/Commercial	$6.89
Rate for Payer: LLUH Dept of Risk Management WC	$6.32
Rate for Payer: Multiplan Commercial	$8.62

ESTERIFIED ESTROGENS 1.25 MG TABLET [9965]

Facility

$4.50

Service Code	NDC 61570-074-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$3.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.70
Rate for Payer: Aetna of CA Government/Medicare	$2.70
Rate for Payer: Cash Price	$2.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.60
Rate for Payer: Health Smart Auto/Commercial	$2.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.70
Rate for Payer: LLUH Dept of Risk Management WC	$2.48
Rate for Payer: Multiplan Commercial	$3.38

ESTERIFIED ESTROGENS 1.25 MG TABLET [9965]

Facility

$4.50

Service Code	NDC 61570-074-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$3.60
Rate for Payer: Cash Price	$2.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.60
Rate for Payer: Health Smart Auto/Commercial	$2.70
Rate for Payer: LLUH Dept of Risk Management WC	$2.48
Rate for Payer: Multiplan Commercial	$3.38

ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]

Facility

$9.73

Service Code	NDC 0430-3754-14
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.35
Max. Negotiated Rate	$7.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.84
Rate for Payer: Aetna of CA Government/Medicare	$5.84
Rate for Payer: Cash Price	$5.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.78
Rate for Payer: Health Smart Auto/Commercial	$5.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.84
Rate for Payer: LLUH Dept of Risk Management WC	$5.35
Rate for Payer: Multiplan Commercial	$7.30

ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]

Facility

$3.07

Service Code	NDC 0093-3541-43
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$2.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.84
Rate for Payer: Aetna of CA Government/Medicare	$1.84
Rate for Payer: Cash Price	$1.69
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.46
Rate for Payer: Health Smart Auto/Commercial	$1.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.84
Rate for Payer: LLUH Dept of Risk Management WC	$1.69
Rate for Payer: Multiplan Commercial	$2.30

ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]

Facility

$3.07

Service Code	NDC 0093-3541-43
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$2.46
Rate for Payer: Cash Price	$1.69
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.46
Rate for Payer: Health Smart Auto/Commercial	$1.84
Rate for Payer: LLUH Dept of Risk Management WC	$1.69
Rate for Payer: Multiplan Commercial	$2.30

ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]

Facility

$9.73

Service Code	NDC 0430-3754-14
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.35
Max. Negotiated Rate	$7.78
Rate for Payer: Cash Price	$5.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.78
Rate for Payer: Health Smart Auto/Commercial	$5.84
Rate for Payer: LLUH Dept of Risk Management WC	$5.35
Rate for Payer: Multiplan Commercial	$7.30

ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]

Facility

$13.04

Service Code	NDC 0781-7129-83
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.17
Max. Negotiated Rate	$10.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.82
Rate for Payer: Aetna of CA Government/Medicare	$7.82
Rate for Payer: Cash Price	$7.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.43
Rate for Payer: Health Smart Auto/Commercial	$7.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.82
Rate for Payer: LLUH Dept of Risk Management WC	$7.17
Rate for Payer: Multiplan Commercial	$9.78

ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]

Facility

$13.04

Service Code	NDC 0781-7129-58
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.17
Max. Negotiated Rate	$10.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.82
Rate for Payer: Aetna of CA Government/Medicare	$7.82
Rate for Payer: Cash Price	$7.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.43
Rate for Payer: Health Smart Auto/Commercial	$7.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.82
Rate for Payer: LLUH Dept of Risk Management WC	$7.17
Rate for Payer: Multiplan Commercial	$9.78

ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]

Facility

$13.04

Service Code	NDC 0781-7129-83
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.17
Max. Negotiated Rate	$10.43
Rate for Payer: Cash Price	$7.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.43
Rate for Payer: Health Smart Auto/Commercial	$7.82
Rate for Payer: LLUH Dept of Risk Management WC	$7.17
Rate for Payer: Multiplan Commercial	$9.78

ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]

Facility

$13.04

Service Code	NDC 0781-7129-58
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$7.17
Max. Negotiated Rate	$10.43
Rate for Payer: Cash Price	$7.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.43
Rate for Payer: Health Smart Auto/Commercial	$7.82
Rate for Payer: LLUH Dept of Risk Management WC	$7.17
Rate for Payer: Multiplan Commercial	$9.78

Know your out-of-pocket cost for care.

All Charges