Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC IOP COGNITIVE THERAPY

Facility

$430.00

Service Code	CPT 90853
Hospital Charge Code	907804061
Hospital Revenue Code	905
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$364.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$236.50
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$322.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC IOP CONNECTION GROUP

Facility

$391.00

Service Code	CPT 90853
Hospital Charge Code	907804376
Hospital Revenue Code	905
Min. Negotiated Rate	$215.05
Max. Negotiated Rate	$652.36
Rate for Payer: Cash Price	$175.95
Rate for Payer: Cash Price	$175.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$312.80
Rate for Payer: Health Smart Auto/Commercial	$234.60
Rate for Payer: LLUH Dept of Risk Management WC	$215.05
Rate for Payer: Mary Free Bed Workers' Compensation	$652.36
Rate for Payer: Multiplan Commercial	$293.25

HC IOP CONNECTION GROUP

Facility

$391.00

Service Code	CPT 90853
Hospital Charge Code	907804376
Hospital Revenue Code	905
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Cash Price	$175.95
Rate for Payer: Cash Price	$175.95
Rate for Payer: Cash Price	$175.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$364.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$215.05
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$293.25
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC IOP COPING SKILLS

Facility

$430.00

Service Code	CPT 90853
Hospital Charge Code	907804060
Hospital Revenue Code	905
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$364.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$236.50
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$322.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC IOP COPING SKILLS

Facility

$430.00

Service Code	CPT 90853
Hospital Charge Code	907804060
Hospital Revenue Code	905
Min. Negotiated Rate	$236.50
Max. Negotiated Rate	$652.36
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$344.00
Rate for Payer: Health Smart Auto/Commercial	$258.00
Rate for Payer: LLUH Dept of Risk Management WC	$236.50
Rate for Payer: Mary Free Bed Workers' Compensation	$652.36
Rate for Payer: Multiplan Commercial	$322.50

HC IOP ED COGNITIVE THERAPY

Facility

$443.00

Service Code	CPT 90853
Hospital Charge Code	907804141
Hospital Revenue Code	905
Min. Negotiated Rate	$243.65
Max. Negotiated Rate	$652.36
Rate for Payer: Cash Price	$199.35
Rate for Payer: Cash Price	$199.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$354.40
Rate for Payer: Health Smart Auto/Commercial	$265.80
Rate for Payer: LLUH Dept of Risk Management WC	$243.65
Rate for Payer: Mary Free Bed Workers' Compensation	$652.36
Rate for Payer: Multiplan Commercial	$332.25

HC IOP ED COGNITIVE THERAPY

Facility

$443.00

Service Code	CPT 90853
Hospital Charge Code	907804141
Hospital Revenue Code	905
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Cash Price	$199.35
Rate for Payer: Cash Price	$199.35
Rate for Payer: Cash Price	$199.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$364.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$243.65
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$332.25
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC IOP ED COPING SKILLS

Facility

$443.00

Service Code	CPT 90853
Hospital Charge Code	907804140
Hospital Revenue Code	905
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Cash Price	$199.35
Rate for Payer: Cash Price	$199.35
Rate for Payer: Cash Price	$199.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$364.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$243.65
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$332.25
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC IOP ED COPING SKILLS

Facility

$443.00

Service Code	CPT 90853
Hospital Charge Code	907804140
Hospital Revenue Code	905
Min. Negotiated Rate	$243.65
Max. Negotiated Rate	$652.36
Rate for Payer: Cash Price	$199.35
Rate for Payer: Cash Price	$199.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$354.40
Rate for Payer: Health Smart Auto/Commercial	$265.80
Rate for Payer: LLUH Dept of Risk Management WC	$243.65
Rate for Payer: Mary Free Bed Workers' Compensation	$652.36
Rate for Payer: Multiplan Commercial	$332.25

HC IOP ED FAMILY THERAPY W PATIENT

Facility

$553.00

Service Code	CPT 90847
Hospital Charge Code	907804156
Hospital Revenue Code	905
Min. Negotiated Rate	$120.20
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Cash Price	$248.85
Rate for Payer: Cash Price	$248.85
Rate for Payer: Cash Price	$248.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$304.15
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Mary Free Bed Workers' Compensation	$120.20
Rate for Payer: Multiplan Commercial	$414.75
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC IOP ED FAMILY THERAPY W PATIENT

Facility

$553.00

Service Code	CPT 90847
Hospital Charge Code	907804156
Hospital Revenue Code	905
Min. Negotiated Rate	$304.15
Max. Negotiated Rate	$652.36
Rate for Payer: Cash Price	$248.85
Rate for Payer: Cash Price	$248.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$442.40
Rate for Payer: Health Smart Auto/Commercial	$331.80
Rate for Payer: LLUH Dept of Risk Management WC	$304.15
Rate for Payer: Mary Free Bed Workers' Compensation	$652.36
Rate for Payer: Multiplan Commercial	$414.75

HC IOP ED INDIV THERAPY

Facility

$512.00

Service Code	CPT 90834
Hospital Charge Code	907804158
Hospital Revenue Code	905
Min. Negotiated Rate	$281.60
Max. Negotiated Rate	$652.36
Rate for Payer: Cash Price	$230.40
Rate for Payer: Cash Price	$230.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$409.60
Rate for Payer: Health Smart Auto/Commercial	$307.20
Rate for Payer: LLUH Dept of Risk Management WC	$281.60
Rate for Payer: Mary Free Bed Workers' Compensation	$652.36
Rate for Payer: Multiplan Commercial	$384.00

HC IOP ED INDIV THERAPY

Facility

$512.00

Service Code	CPT 90834
Hospital Charge Code	907804158
Hospital Revenue Code	905
Min. Negotiated Rate	$281.60
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Cash Price	$230.40
Rate for Payer: Cash Price	$230.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$281.60
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Multiplan Commercial	$384.00
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC IOP ED PROCESS GROUP

Facility

$443.00

Service Code	CPT 90853
Hospital Charge Code	907804142
Hospital Revenue Code	905
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Cash Price	$199.35
Rate for Payer: Cash Price	$199.35
Rate for Payer: Cash Price	$199.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$364.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$243.65
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$332.25
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC IOP ED PROCESS GROUP

Facility

$443.00

Service Code	CPT 90853
Hospital Charge Code	907804142
Hospital Revenue Code	905
Min. Negotiated Rate	$243.65
Max. Negotiated Rate	$652.36
Rate for Payer: Cash Price	$199.35
Rate for Payer: Cash Price	$199.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$354.40
Rate for Payer: Health Smart Auto/Commercial	$265.80
Rate for Payer: LLUH Dept of Risk Management WC	$243.65
Rate for Payer: Mary Free Bed Workers' Compensation	$652.36
Rate for Payer: Multiplan Commercial	$332.25

HC IOP OT TASK GROUP

Facility

$239.00

Service Code	CPT 90853
Hospital Charge Code	907804067
Hospital Revenue Code	905
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Cash Price	$107.55
Rate for Payer: Cash Price	$107.55
Rate for Payer: Cash Price	$107.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$364.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$131.45
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$179.25
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC IOP OT TASK GROUP

Facility

$239.00

Service Code	CPT 90853
Hospital Charge Code	907804067
Hospital Revenue Code	905
Min. Negotiated Rate	$131.45
Max. Negotiated Rate	$652.36
Rate for Payer: Cash Price	$107.55
Rate for Payer: Cash Price	$107.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$191.20
Rate for Payer: Health Smart Auto/Commercial	$143.40
Rate for Payer: LLUH Dept of Risk Management WC	$131.45
Rate for Payer: Mary Free Bed Workers' Compensation	$652.36
Rate for Payer: Multiplan Commercial	$179.25

HC IOP PROCESS GROUP

Facility

$430.00

Service Code	CPT 90853
Hospital Charge Code	907804062
Hospital Revenue Code	905
Min. Negotiated Rate	$236.50
Max. Negotiated Rate	$652.36
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$344.00
Rate for Payer: Health Smart Auto/Commercial	$258.00
Rate for Payer: LLUH Dept of Risk Management WC	$236.50
Rate for Payer: Mary Free Bed Workers' Compensation	$652.36
Rate for Payer: Multiplan Commercial	$322.50

HC IOP PROCESS GROUP

Facility

$430.00

Service Code	CPT 90853
Hospital Charge Code	907804062
Hospital Revenue Code	905
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$364.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$236.50
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$322.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC IOP SHIELD GROUP

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804378
Hospital Revenue Code	905
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$364.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$280.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC IOP SHIELD GROUP

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804378
Hospital Revenue Code	905
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$652.36
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$299.20
Rate for Payer: Health Smart Auto/Commercial	$224.40
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Mary Free Bed Workers' Compensation	$652.36
Rate for Payer: Multiplan Commercial	$280.50

HC IOP WISDOM GROUP

Facility

$430.00

Service Code	CPT 90853
Hospital Charge Code	907804374
Hospital Revenue Code	905
Min. Negotiated Rate	$236.50
Max. Negotiated Rate	$652.36
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$344.00
Rate for Payer: Health Smart Auto/Commercial	$258.00
Rate for Payer: LLUH Dept of Risk Management WC	$236.50
Rate for Payer: Mary Free Bed Workers' Compensation	$652.36
Rate for Payer: Multiplan Commercial	$322.50

HC IOP WISDOM GROUP

Facility

$430.00

Service Code	CPT 90853
Hospital Charge Code	907804374
Hospital Revenue Code	905
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$364.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$236.50
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$322.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC IRON BINDING CAPACITY

Facility

$179.00

Service Code	CPT 83550
Hospital Charge Code	900910437
Hospital Revenue Code	301
Min. Negotiated Rate	$98.45
Max. Negotiated Rate	$143.20
Rate for Payer: Cash Price	$80.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$143.20
Rate for Payer: Health Smart Auto/Commercial	$107.40
Rate for Payer: LLUH Dept of Risk Management WC	$98.45
Rate for Payer: Multiplan Commercial	$134.25

HC IRON BINDING CAPACITY

Facility

$56.63

Service Code	CPT 83550
Hospital Charge Code	900910437
Hospital Revenue Code	301
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$45.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$33.98
Rate for Payer: Aetna of CA Government/Medicare	$33.98
Rate for Payer: Cash Price	$25.48
Rate for Payer: Cash Price	$25.48
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$45.30
Rate for Payer: Health Smart Auto/Commercial	$33.98
Rate for Payer: Intervalley Health Plan Commercial	$8.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$33.98
Rate for Payer: LLUH Dept of Risk Management WC	$31.15
Rate for Payer: Multiplan Commercial	$42.47

Know your out-of-pocket cost for care.

All Charges