Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC ALLERGEN TURKEY IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900913608
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 TURKEY IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900913608
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 VANILLA IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900913504
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 VANILLA IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900913504
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 WALNUT IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900913505
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 WALNUT IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900913505
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 WHEAT IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900913506
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 WHEAT IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900913506
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 YELLOW JACKET VENOM IGE

Facility

$50.00

Service Code	CPT 86003
Hospital Charge Code	900913609
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 YELLOW JACKET VENOM IGE

Facility

$66.00

Service Code	CPT 86003
Hospital Charge Code	900913609
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 ALPHA 1 ANTITRYPSN

Facility

$113.00

Service Code	CPT 82103
Hospital Charge Code	900910838
Hospital Revenue Code	301
Min. Negotiated Rate	$62.15
Max. Negotiated Rate	$90.40
Rate for Payer: Cash Price	$50.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$90.40
Rate for Payer: Health Smart Auto/Commercial	$67.80
Rate for Payer: LLUH Dept of Risk Management WC	$62.15
Rate for Payer: Multiplan Commercial	$84.75

HC ALPHA 1 ANTITRYPSN

Facility

$62.00

Service Code	CPT 82103
Hospital Charge Code	900910838
Hospital Revenue Code	301
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$49.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$37.20
Rate for Payer: Aetna of CA Government/Medicare	$37.20
Rate for Payer: Cash Price	$27.90
Rate for Payer: Cash Price	$27.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$49.60
Rate for Payer: Health Smart Auto/Commercial	$37.20
Rate for Payer: Intervalley Health Plan Commercial	$13.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$37.20
Rate for Payer: LLUH Dept of Risk Management WC	$34.10
Rate for Payer: Multiplan Commercial	$46.50

HC ALPHA-FETOPROTEIN BLOOD

Facility

$270.00

Service Code	CPT 82105
Hospital Charge Code	900910947
Hospital Revenue Code	301
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$216.00
Rate for Payer: Cash Price	$121.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$216.00
Rate for Payer: Health Smart Auto/Commercial	$162.00
Rate for Payer: LLUH Dept of Risk Management WC	$148.50
Rate for Payer: Multiplan Commercial	$202.50

HC ALPHA-FETOPROTEIN BLOOD

Facility

$140.00

Service Code	CPT 82105
Hospital Charge Code	900910947
Hospital Revenue Code	301
Min. Negotiated Rate	$16.77
Max. Negotiated Rate	$112.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$84.00
Rate for Payer: Aetna of CA Government/Medicare	$84.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$112.00
Rate for Payer: Health Smart Auto/Commercial	$84.00
Rate for Payer: Intervalley Health Plan Commercial	$16.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$84.00
Rate for Payer: LLUH Dept of Risk Management WC	$77.00
Rate for Payer: Multiplan Commercial	$105.00

HC ALT

Facility

$98.00

Service Code	CPT 84460
Hospital Charge Code	900910233
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 ALT

Facility

$50.00

Service Code	CPT 84460
Hospital Charge Code	900910233
Hospital Revenue Code	301
Min. Negotiated Rate	$5.30
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	$5.30
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 ALT SINGLE

Facility

$98.00

Service Code	CPT 84460
Hospital Charge Code	900910510
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 ALT SINGLE

Facility

$50.00

Service Code	CPT 84460
Hospital Charge Code	900910510
Hospital Revenue Code	301
Min. Negotiated Rate	$5.30
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	$5.30
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 AMIKACIN

Facility

$172.00

Service Code	CPT 80150
Hospital Charge Code	900910405
Hospital Revenue Code	301
Min. Negotiated Rate	$94.60
Max. Negotiated Rate	$137.60
Rate for Payer: Cash Price	$77.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$137.60
Rate for Payer: Health Smart Auto/Commercial	$103.20
Rate for Payer: LLUH Dept of Risk Management WC	$94.60
Rate for Payer: Multiplan Commercial	$129.00

HC AMIKACIN

Facility

$51.00

Service Code	CPT 80150
Hospital Charge Code	900910405
Hospital Revenue Code	301
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$40.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.60
Rate for Payer: Aetna of CA Government/Medicare	$30.60
Rate for Payer: Cash Price	$22.95
Rate for Payer: Cash Price	$22.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.80
Rate for Payer: Health Smart Auto/Commercial	$30.60
Rate for Payer: Intervalley Health Plan Commercial	$15.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.60
Rate for Payer: LLUH Dept of Risk Management WC	$28.05
Rate for Payer: Multiplan Commercial	$38.25

HC AMMONIA

Facility

$124.00

Service Code	CPT 82140
Hospital Charge Code	900910276
Hospital Revenue Code	301
Min. Negotiated Rate	$14.57
Max. Negotiated Rate	$99.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$74.40
Rate for Payer: Aetna of CA Government/Medicare	$74.40
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cash Price	$55.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$99.20
Rate for Payer: Health Smart Auto/Commercial	$74.40
Rate for Payer: Intervalley Health Plan Commercial	$14.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$74.40
Rate for Payer: LLUH Dept of Risk Management WC	$68.20
Rate for Payer: Multiplan Commercial	$93.00

HC AMMONIA

Facility

$449.00

Service Code	CPT 82140
Hospital Charge Code	900910276
Hospital Revenue Code	301
Min. Negotiated Rate	$246.95
Max. Negotiated Rate	$359.20
Rate for Payer: Cash Price	$202.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$359.20
Rate for Payer: Health Smart Auto/Commercial	$269.40
Rate for Payer: LLUH Dept of Risk Management WC	$246.95
Rate for Payer: Multiplan Commercial	$336.75

HC AMNIOTIC FLUID SCA

Facility

$280.00

Service Code	CPT 82143
Hospital Charge Code	900910277
Hospital Revenue Code	301
Min. Negotiated Rate	$154.00
Max. Negotiated Rate	$224.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$224.00
Rate for Payer: Health Smart Auto/Commercial	$168.00
Rate for Payer: LLUH Dept of Risk Management WC	$154.00
Rate for Payer: Multiplan Commercial	$210.00

HC AMNIOTIC FLUID SCA

Facility

$29.00

Service Code	CPT 82143
Hospital Charge Code	900910277
Hospital Revenue Code	301
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$23.20
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: Cash Price	$13.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$23.20
Rate for Payer: Health Smart Auto/Commercial	$17.40
Rate for Payer: Intervalley Health Plan Commercial	$9.35
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 Commercial	$21.75

HC AMPHETAMINES CONF & ID

Facility

$298.00

Service Code	CPT 80324
Hospital Charge Code	900910520
Hospital Revenue Code	301
Min. Negotiated Rate	$163.90
Max. Negotiated Rate	$238.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$178.80
Rate for Payer: Aetna of CA Government/Medicare	$178.80
Rate for Payer: Cash Price	$134.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$238.40
Rate for Payer: Health Smart Auto/Commercial	$178.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$178.80
Rate for Payer: LLUH Dept of Risk Management WC	$163.90
Rate for Payer: Multiplan Commercial	$223.50

Know your out-of-pocket cost for care.

All Charges