Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC ALBUMIN BODY FLUID

Facility

$27.00

Service Code	CPT 82042
Hospital Charge Code	900910715
Hospital Revenue Code	301
Min. Negotiated Rate	$7.78
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.20
Rate for Payer: Aetna of CA Government/Medicare	$16.20
Rate for Payer: Cash Price	$12.15
Rate for Payer: Cash Price	$12.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$21.60
Rate for Payer: Health Smart Auto/Commercial	$16.20
Rate for Payer: Intervalley Health Plan Commercial	$7.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.20
Rate for Payer: LLUH Dept of Risk Management WC	$14.85
Rate for Payer: Multiplan Commercial	$20.25

HC ALBUMIN INDIVIDUAL

Facility

$50.00

Service Code	CPT 82040
Hospital Charge Code	900910497
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$40.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC ALBUMIN INDIVIDUAL

Facility

$50.00

Service Code	CPT 82040
Hospital Charge Code	900910497
Hospital Revenue Code	301
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Intervalley Health Plan Commercial	$4.95
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC ALCOHOL ETHANOL (SERUM/URINE)

Facility

$56.00

Service Code	CPT 80320
Hospital Charge Code	900910322
Hospital Revenue Code	301
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$44.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$33.60
Rate for Payer: Aetna of CA Government/Medicare	$33.60
Rate for Payer: Cash Price	$25.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$44.80
Rate for Payer: Health Smart Auto/Commercial	$33.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$33.60
Rate for Payer: LLUH Dept of Risk Management WC	$30.80
Rate for Payer: Multiplan Commercial	$42.00

HC ALCOHOL ETHANOL (SERUM/URINE)

Facility

$503.00

Service Code	CPT 80320
Hospital Charge Code	900910322
Hospital Revenue Code	301
Min. Negotiated Rate	$276.65
Max. Negotiated Rate	$402.40
Rate for Payer: Cash Price	$226.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$402.40
Rate for Payer: Health Smart Auto/Commercial	$301.80
Rate for Payer: LLUH Dept of Risk Management WC	$276.65
Rate for Payer: Multiplan Commercial	$377.25

HC ALELRGEN CUCUMBER IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900913581
Hospital Revenue Code	302
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$52.80
Rate for Payer: Cash Price	$29.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$52.80
Rate for Payer: Health Smart Auto/Commercial	$39.60
Rate for Payer: LLUH Dept of Risk Management WC	$36.30
Rate for Payer: Multiplan Commercial	$49.50

HC ALELRGEN CUCUMBER IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900913581
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Intervalley Health Plan Commercial	$5.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC ALELRGEN GRAPEFRUIT IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900913587
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Intervalley Health Plan Commercial	$5.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC ALELRGEN GRAPEFRUIT IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900913587
Hospital Revenue Code	302
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$52.80
Rate for Payer: Cash Price	$29.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$52.80
Rate for Payer: Health Smart Auto/Commercial	$39.60
Rate for Payer: LLUH Dept of Risk Management WC	$36.30
Rate for Payer: Multiplan Commercial	$49.50

HC ALKALINE PHOSPHATASE

Facility

$94.00

Service Code	CPT 84075
Hospital Charge Code	900910219
Hospital Revenue Code	301
Min. Negotiated Rate	$51.70
Max. Negotiated Rate	$75.20
Rate for Payer: Cash Price	$42.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$75.20
Rate for Payer: Health Smart Auto/Commercial	$56.40
Rate for Payer: LLUH Dept of Risk Management WC	$51.70
Rate for Payer: Multiplan Commercial	$70.50

HC ALKALINE PHOSPHATASE

Facility

$34.00

Service Code	CPT 84075
Hospital Charge Code	900910219
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
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	$5.18
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 ALKALINE PHOSPHATASE INDIV

Facility

$34.00

Service Code	CPT 84075
Hospital Charge Code	900910508
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
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	$5.18
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 ALKALINE PHOSPHATASE INDIV

Facility

$98.00

Service Code	CPT 84075
Hospital Charge Code	900910508
Hospital Revenue Code	301
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$78.40
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: LLUH Dept of Risk Management WC	$53.90
Rate for Payer: Multiplan Commercial	$73.50

HC ALLELRGEN GREEN PEPPER IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900913601
Hospital Revenue Code	302
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$52.80
Rate for Payer: Cash Price	$29.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$52.80
Rate for Payer: Health Smart Auto/Commercial	$39.60
Rate for Payer: LLUH Dept of Risk Management WC	$36.30
Rate for Payer: Multiplan Commercial	$49.50

HC ALLELRGEN GREEN PEPPER IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900913601
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Intervalley Health Plan Commercial	$5.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC ALLERGEN A ALTERNATA IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900912344
Hospital Revenue Code	302
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$52.80
Rate for Payer: Cash Price	$29.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$52.80
Rate for Payer: Health Smart Auto/Commercial	$39.60
Rate for Payer: LLUH Dept of Risk Management WC	$36.30
Rate for Payer: Multiplan Commercial	$49.50

HC ALLERGEN A ALTERNATA IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900912344
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Intervalley Health Plan Commercial	$5.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC ALLERGEN ALDER E IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900912345
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Intervalley Health Plan Commercial	$5.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC ALLERGEN ALDER E IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900912345
Hospital Revenue Code	302
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$52.80
Rate for Payer: Cash Price	$29.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$52.80
Rate for Payer: Health Smart Auto/Commercial	$39.60
Rate for Payer: LLUH Dept of Risk Management WC	$36.30
Rate for Payer: Multiplan Commercial	$49.50

HC ALLERGEN ALMOND IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900912346
Hospital Revenue Code	302
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$52.80
Rate for Payer: Cash Price	$29.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$52.80
Rate for Payer: Health Smart Auto/Commercial	$39.60
Rate for Payer: LLUH Dept of Risk Management WC	$36.30
Rate for Payer: Multiplan Commercial	$49.50

HC ALLERGEN ALMOND IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900912346
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Intervalley Health Plan Commercial	$5.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC ALLERGEN ALPHA-LACTOALBUMIN IGE

Facility

$26.00

Service Code	CPT 86008
Hospital Charge Code	900913570
Hospital Revenue Code	302
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$20.80
Rate for Payer: Cash Price	$11.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$20.80
Rate for Payer: Health Smart Auto/Commercial	$15.60
Rate for Payer: LLUH Dept of Risk Management WC	$14.30
Rate for Payer: Multiplan Commercial	$19.50

HC ALLERGEN ALPHA-LACTOALBUMIN IGE

Facility

$24.00

Service Code	CPT 86008
Hospital Charge Code	900913570
Hospital Revenue Code	302
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$19.20
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: Cash Price	$10.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.20
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: Intervalley Health Plan Commercial	$17.93
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 Commercial	$18.00

HC ALLERGEN APPLE IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900912347
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Intervalley Health Plan Commercial	$5.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC ALLERGEN APPLE IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900912347
Hospital Revenue Code	302
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$52.80
Rate for Payer: Cash Price	$29.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$52.80
Rate for Payer: Health Smart Auto/Commercial	$39.60
Rate for Payer: LLUH Dept of Risk Management WC	$36.30
Rate for Payer: Multiplan Commercial	$49.50

Know your out-of-pocket cost for care.

All Charges