Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC EBNA IGG

Facility

$25.00

Service Code	CPT 86664
Hospital Charge Code	900913537
Hospital Revenue Code	302
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$18.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.00
Rate for Payer: Aetna of CA Government/Medicare	$15.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.75

HC EBV IGG EARLY AB

Facility

$20.00

Service Code	CPT 86663
Hospital Charge Code	900913538
Hospital Revenue Code	302
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.00
Rate for Payer: Aetna of CA Government/Medicare	$12.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.00

HC EBV IGG EARLY AB

Facility

$204.00

Service Code	CPT 86663
Hospital Charge Code	900913538
Hospital Revenue Code	302
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$163.20
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna of CA HMO/PPO	$163.20
Rate for Payer: Health Smart Auto/Commercial	$122.40
Rate for Payer: LLUH Dept of Risk Management WC	$112.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$153.00

HC EBV PCR

Facility

$516.00

Service Code	CPT 87799
Hospital Charge Code	900912315
Hospital Revenue Code	300
Min. Negotiated Rate	$283.80
Max. Negotiated Rate	$412.80
Rate for Payer: Cash Price	$232.20
Rate for Payer: Cigna of CA HMO/PPO	$412.80
Rate for Payer: Health Smart Auto/Commercial	$309.60
Rate for Payer: LLUH Dept of Risk Management WC	$283.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$387.00

HC EBV PCR

Facility

$125.00

Service Code	CPT 87799
Hospital Charge Code	900912315
Hospital Revenue Code	300
Min. Negotiated Rate	$68.75
Max. Negotiated Rate	$93.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$75.00
Rate for Payer: Aetna of CA Government/Medicare	$75.00
Rate for Payer: Cash Price	$56.25
Rate for Payer: Health Smart Auto/Commercial	$75.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$75.00
Rate for Payer: LLUH Dept of Risk Management WC	$68.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$93.75

HC EBV-VCA IGG/IGM

Facility

$204.00

Service Code	CPT 86665
Hospital Charge Code	900913535
Hospital Revenue Code	302
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$163.20
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna of CA HMO/PPO	$163.20
Rate for Payer: Health Smart Auto/Commercial	$122.40
Rate for Payer: LLUH Dept of Risk Management WC	$112.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$153.00

HC EBV-VCA IGG/IGM

Facility

$28.00

Service Code	CPT 86665
Hospital Charge Code	900913535
Hospital Revenue Code	302
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.80
Rate for Payer: Aetna of CA Government/Medicare	$16.80
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Smart Auto/Commercial	$16.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.80
Rate for Payer: LLUH Dept of Risk Management WC	$15.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21.00

HC ED FAMILY THERAPY WITH PATIENT

Facility

$460.00

Service Code	CPT 90847
Hospital Charge Code	907804116
Hospital Revenue Code	916
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$345.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$176.80
Rate for Payer: Aetna of CA Government/Medicare	$176.80
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Health Smart Auto/Commercial	$276.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$276.00
Rate for Payer: LLUH Dept of Risk Management WC	$253.00
Rate for Payer: Mary Free Bed Workers' Compensation	$110.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$345.00

HC ED FAMILY THERAPY WITH PATIENT

Facility

$460.00

Service Code	CPT 90847
Hospital Charge Code	907804116
Hospital Revenue Code	905
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$475.00
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	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cigna of CA HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Heritage Provider Network Commercial	$281.00
Rate for Payer: Heritage Provider Network Senior	$281.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$293.00
Rate for Payer: LLUH Dept of Risk Management WC	$253.00
Rate for Payer: Magellan Commercial	$406.00
Rate for Payer: Managed Health Network (MHN) Commercial	$434.00
Rate for Payer: Managed Health Network (MHN) Medicare	$199.21
Rate for Payer: Mary Free Bed Workers' Compensation	$110.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$345.00
Rate for Payer: US Behavioral Health Commercial/Medicare	$397.33

HC ED FAMILY THERAPY WITH PATIENT

Facility

$460.00

Service Code	CPT 90847
Hospital Charge Code	907804116
Hospital Revenue Code	916
Min. Negotiated Rate	$253.00
Max. Negotiated Rate	$368.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cigna of CA HMO/PPO	$368.00
Rate for Payer: Health Smart Auto/Commercial	$276.00
Rate for Payer: LLUH Dept of Risk Management WC	$253.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$345.00

HC ED FAMILY THERAPY WITH PATIENT

Facility

$460.00

Service Code	CPT 90847
Hospital Charge Code	907804116
Hospital Revenue Code	905
Min. Negotiated Rate	$253.00
Max. Negotiated Rate	$469.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cigna of CA HMO/PPO	$368.00
Rate for Payer: Health Smart Auto/Commercial	$276.00
Rate for Payer: LLUH Dept of Risk Management WC	$253.00
Rate for Payer: Mary Free Bed Workers' Compensation	$469.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$345.00

HC ED INDIV BRIEF THERAPY

Facility

$335.00

Service Code	CPT 90832
Hospital Charge Code	907804117
Hospital Revenue Code	914
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$102.00
Rate for Payer: Aetna of CA Government/Medicare	$102.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Cash Price	$150.75
Rate for Payer: Cash Price	$150.75
Rate for Payer: Cash Price	$150.75
Rate for Payer: Health Smart Auto/Commercial	$201.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$201.00
Rate for Payer: LLUH Dept of Risk Management WC	$184.25
Rate for Payer: Mary Free Bed Workers' Compensation	$75.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$251.25

HC ED INDIV BRIEF THERAPY

Facility

$335.00

Service Code	CPT 90832
Hospital Charge Code	907804117
Hospital Revenue Code	914
Min. Negotiated Rate	$184.25
Max. Negotiated Rate	$268.00
Rate for Payer: Cash Price	$150.75
Rate for Payer: Cigna of CA HMO/PPO	$268.00
Rate for Payer: Health Smart Auto/Commercial	$201.00
Rate for Payer: LLUH Dept of Risk Management WC	$184.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$251.25

HC ED INDIV THERAPY

Facility

$425.00

Service Code	CPT 90834
Hospital Charge Code	907804118
Hospital Revenue Code	905
Min. Negotiated Rate	$199.21
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$475.00
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	$191.25
Rate for Payer: Cash Price	$191.25
Rate for Payer: Cash Price	$191.25
Rate for Payer: Cigna of CA HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Heritage Provider Network Commercial	$281.00
Rate for Payer: Heritage Provider Network Senior	$281.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$293.00
Rate for Payer: LLUH Dept of Risk Management WC	$233.75
Rate for Payer: Magellan Commercial	$406.00
Rate for Payer: Managed Health Network (MHN) Commercial	$434.00
Rate for Payer: Managed Health Network (MHN) Medicare	$199.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$318.75
Rate for Payer: US Behavioral Health Commercial/Medicare	$397.33

HC ED INDIV THERAPY

Facility

$425.00

Service Code	CPT 90834
Hospital Charge Code	907804118
Hospital Revenue Code	914
Min. Negotiated Rate	$233.75
Max. Negotiated Rate	$340.00
Rate for Payer: Cash Price	$191.25
Rate for Payer: Cigna of CA HMO/PPO	$340.00
Rate for Payer: Health Smart Auto/Commercial	$255.00
Rate for Payer: LLUH Dept of Risk Management WC	$233.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$318.75

HC ED INDIV THERAPY

Facility

$425.00

Service Code	CPT 90834
Hospital Charge Code	907804118
Hospital Revenue Code	914
Min. Negotiated Rate	$149.60
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$149.60
Rate for Payer: Aetna of CA Government/Medicare	$149.60
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Cash Price	$191.25
Rate for Payer: Cash Price	$191.25
Rate for Payer: Cash Price	$191.25
Rate for Payer: Health Smart Auto/Commercial	$255.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$255.00
Rate for Payer: LLUH Dept of Risk Management WC	$233.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$318.75

HC ED INDIV THERAPY

Facility

$425.00

Service Code	CPT 90834
Hospital Charge Code	907804118
Hospital Revenue Code	905
Min. Negotiated Rate	$233.75
Max. Negotiated Rate	$469.00
Rate for Payer: Cash Price	$191.25
Rate for Payer: Cash Price	$191.25
Rate for Payer: Cigna of CA HMO/PPO	$340.00
Rate for Payer: Health Smart Auto/Commercial	$255.00
Rate for Payer: LLUH Dept of Risk Management WC	$233.75
Rate for Payer: Mary Free Bed Workers' Compensation	$469.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$318.75

HC ED INTENSIVE OUT (ADOL)

Facility

$960.00

Hospital Charge Code	907300015
Hospital Revenue Code	913
Min. Negotiated Rate	$528.00
Max. Negotiated Rate	$906.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cigna of CA HMO/PPO	$768.00
Rate for Payer: Health Smart Auto/Commercial	$576.00
Rate for Payer: LLUH Dept of Risk Management WC	$528.00
Rate for Payer: Mary Free Bed Workers' Compensation	$906.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$720.00

HC ED INTENSIVE OUT (ADOL)

Facility

$960.00

Service Code	CPT 90853
Hospital Charge Code	907300015
Hospital Revenue Code	905
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$720.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$475.00
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	$432.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cigna of CA HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Heritage Provider Network Commercial	$281.00
Rate for Payer: Heritage Provider Network Senior	$281.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$293.00
Rate for Payer: LLUH Dept of Risk Management WC	$528.00
Rate for Payer: Magellan Commercial	$406.00
Rate for Payer: Managed Health Network (MHN) Commercial	$434.00
Rate for Payer: Managed Health Network (MHN) Medicare	$111.37
Rate for Payer: Mary Free Bed Workers' Compensation	$41.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$720.00
Rate for Payer: US Behavioral Health Commercial/Medicare	$397.33

HC ED INTENSIVE OUT (ADOL)

Facility

$960.00

Service Code	CPT 90853
Hospital Charge Code	907300015
Hospital Revenue Code	915
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$720.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$55.76
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Health Smart Auto/Commercial	$576.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$576.00
Rate for Payer: LLUH Dept of Risk Management WC	$528.00
Rate for Payer: Mary Free Bed Workers' Compensation	$41.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$720.00

HC ED INTENSIVE OUT (ADOL)

Facility

$960.00

Service Code	CPT 90853
Hospital Charge Code	907300015
Hospital Revenue Code	915
Min. Negotiated Rate	$528.00
Max. Negotiated Rate	$768.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cigna of CA HMO/PPO	$768.00
Rate for Payer: Health Smart Auto/Commercial	$576.00
Rate for Payer: LLUH Dept of Risk Management WC	$528.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$720.00

HC ED INTENSIVE OUT (ADOL)

Facility

$960.00

Service Code	CPT 90853
Hospital Charge Code	907300015
Hospital Revenue Code	905
Min. Negotiated Rate	$469.00
Max. Negotiated Rate	$768.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cigna of CA HMO/PPO	$768.00
Rate for Payer: Health Smart Auto/Commercial	$576.00
Rate for Payer: LLUH Dept of Risk Management WC	$528.00
Rate for Payer: Mary Free Bed Workers' Compensation	$469.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$720.00

HC ED INTENSIVE OUT (ADOL)

Facility

$960.00

Hospital Charge Code	907300015
Hospital Revenue Code	913
Min. Negotiated Rate	$498.68
Max. Negotiated Rate	$926.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$725.00
Rate for Payer: Aetna of CA Government/Medicare	$576.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$700.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Health Smart Auto/Commercial	$926.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$576.00
Rate for Payer: LLUH Dept of Risk Management WC	$528.00
Rate for Payer: Magellan Commercial	$637.00
Rate for Payer: Managed Health Network (MHN) Commercial	$682.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$720.00
Rate for Payer: US Behavioral Health Commercial/Medicare	$498.68

HC ED INTERACTIVE GROUP THERAPY

Facility

$335.00

Service Code	CPT 90853
Hospital Charge Code	907804101
Hospital Revenue Code	912
Min. Negotiated Rate	$184.25
Max. Negotiated Rate	$597.00
Rate for Payer: Cash Price	$150.75
Rate for Payer: Cigna of CA HMO/PPO	$268.00
Rate for Payer: Health Smart Auto/Commercial	$201.00
Rate for Payer: Cash Price	$150.75
Rate for Payer: LLUH Dept of Risk Management WC	$184.25
Rate for Payer: Mary Free Bed Workers' Compensation	$597.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$251.25

HC ED INTERACTIVE GROUP THERAPY

Facility

$335.00

Service Code	CPT G0411
Hospital Charge Code	907804101
Hospital Revenue Code	915
Min. Negotiated Rate	$184.25
Max. Negotiated Rate	$268.00
Rate for Payer: Cash Price	$150.75
Rate for Payer: Cigna of CA HMO/PPO	$268.00
Rate for Payer: Health Smart Auto/Commercial	$201.00
Rate for Payer: LLUH Dept of Risk Management WC	$184.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$251.25

Know your out-of-pocket cost for care.

All Charges