Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC ALLERGEN GRAPE IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900912369
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 GRAPE IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900912369
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 GREEN PEA IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900913511
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 GREEN PEA IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900913511
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 GREEN STRING BEAN IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900912370
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 GREEN STRING BEAN IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900912370
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 GUINEA PIG EPITHELIUM IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900913588
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 GUINEA PIG EPITHELIUM IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900913588
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 HALIBUT IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900912371
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 HALIBUT IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900912371
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 HAMSTER EPITHELIUM IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900913589
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 HAMSTER EPITHELIUM IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900913589
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 HAZELNUT IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900913509
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 HAZELNUT IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900913509
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 HD MITE DF IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900912372
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 HD MITE DF IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900912372
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 HD MITE DP IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900912373
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 HD MITE DP IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900912373
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 HONEYBEE VENOM IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900913590
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 HONEYBEE VENOM IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900913590
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 HORSE DANDER IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900912374
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 HORSE DANDER IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900912374
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 HOUSE DUST MITES IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900912375
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 HOUSE DUST MITES IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900912375
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 JAPANESE CEDAR IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900913552
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

Know your out-of-pocket cost for care.

All Charges