Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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	$400.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$201.00
Rate for Payer: Aetna of CA Government/Medicare	$201.00
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: 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: 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

HC ED INTERACTIVE GROUP THERAPY

Facility

$335.00

Service Code	CPT 90853
Hospital Charge Code	907804101
Hospital Revenue Code	915
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$400.00
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	$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	$41.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$251.25

HC ED INTERACTIVE GROUP THERAPY

Facility

$335.00

Service Code	CPT 90853
Hospital Charge Code	907804101
Hospital Revenue Code	912
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$725.00
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$150.75
Rate for Payer: Cash Price	$150.75
Rate for Payer: Cash Price	$150.75
Rate for Payer: Cigna of CA HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Heritage Provider Network Commercial	$472.00
Rate for Payer: Heritage Provider Network Senior	$472.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$463.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$522.00
Rate for Payer: LLUH Dept of Risk Management WC	$184.25
Rate for Payer: Magellan Commercial	$637.00
Rate for Payer: Managed Health Network (MHN) Commercial	$682.00
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	$251.25
Rate for Payer: US Behavioral Health Commercial/Medicare	$498.68

HC ED OT TASK GROUP

Facility

$312.00

Service Code	CPT 90853
Hospital Charge Code	907804115
Hospital Revenue Code	431
Min. Negotiated Rate	$171.60
Max. Negotiated Rate	$249.60
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cigna of CA HMO/PPO	$249.60
Rate for Payer: Health Smart Auto/Commercial	$187.20
Rate for Payer: LLUH Dept of Risk Management WC	$171.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$234.00

HC ED OT TASK GROUP

Facility

$312.00

Service Code	CPT 90853
Hospital Charge Code	907804115
Hospital Revenue Code	912
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$725.00
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cigna of CA HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Heritage Provider Network Commercial	$472.00
Rate for Payer: Heritage Provider Network Senior	$472.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$463.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$522.00
Rate for Payer: LLUH Dept of Risk Management WC	$171.60
Rate for Payer: Magellan Commercial	$637.00
Rate for Payer: Managed Health Network (MHN) Commercial	$682.00
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	$234.00
Rate for Payer: US Behavioral Health Commercial/Medicare	$498.68

HC ED OT TASK GROUP

Facility

$312.00

Service Code	CPT G0177 GO
Hospital Charge Code	907804115
Hospital Revenue Code	942
Min. Negotiated Rate	$171.60
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$187.20
Rate for Payer: Aetna of CA Government/Medicare	$187.20
Rate for Payer: Cash Price	$140.40
Rate for Payer: Health Smart Auto/Commercial	$187.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$187.20
Rate for Payer: LLUH Dept of Risk Management WC	$171.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$234.00

HC ED OT TASK GROUP

Facility

$312.00

Service Code	CPT G0177 GO
Hospital Charge Code	907804115
Hospital Revenue Code	942
Min. Negotiated Rate	$171.60
Max. Negotiated Rate	$249.60
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cigna of CA HMO/PPO	$249.60
Rate for Payer: Health Smart Auto/Commercial	$187.20
Rate for Payer: LLUH Dept of Risk Management WC	$171.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$234.00

HC ED OT TASK GROUP

Facility

$312.00

Service Code	CPT 90853
Hospital Charge Code	907804115
Hospital Revenue Code	431
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$234.00
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: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Health Smart Auto/Commercial	$187.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$187.20
Rate for Payer: LLUH Dept of Risk Management WC	$171.60
Rate for Payer: Mary Free Bed Workers' Compensation	$41.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$234.00

HC ED OT TASK GROUP

Facility

$312.00

Service Code	CPT 90853
Hospital Charge Code	907804115
Hospital Revenue Code	912
Min. Negotiated Rate	$171.60
Max. Negotiated Rate	$597.00
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cigna of CA HMO/PPO	$249.60
Rate for Payer: Health Smart Auto/Commercial	$187.20
Rate for Payer: LLUH Dept of Risk Management WC	$171.60
Rate for Payer: Mary Free Bed Workers' Compensation	$597.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$234.00

HC EDUCATION ED MENTAL HEALTH

Facility

$335.00

Service Code	CPT G0177
Hospital Charge Code	907804100
Hospital Revenue Code	942
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 EDUCATION ED MENTAL HEALTH

Facility

$335.00

Service Code	CPT 90853
Hospital Charge Code	907804100
Hospital Revenue Code	942
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$251.25
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: 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	$41.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$251.25

HC EDUCATION ED MENTAL HEALTH

Facility

$335.00

Service Code	CPT 90853
Hospital Charge Code	907804100
Hospital Revenue Code	942
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 EDUCATION ED MENTAL HEALTH

Facility

$335.00

Service Code	CPT G0177
Hospital Charge Code	907804100
Hospital Revenue Code	942
Min. Negotiated Rate	$184.25
Max. Negotiated Rate	$251.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$201.00
Rate for Payer: Aetna of CA Government/Medicare	$201.00
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: Multiplan Beech St/Commercial/PHCS	$251.25

HC EDUCATION MENTAL HEALTH

Facility

$325.00

Service Code	CPT G0177
Hospital Charge Code	907804065
Hospital Revenue Code	942
Min. Negotiated Rate	$178.75
Max. Negotiated Rate	$260.00
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cigna of CA HMO/PPO	$260.00
Rate for Payer: Health Smart Auto/Commercial	$195.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

HC EDUCATION MENTAL HEALTH

Facility

$325.00

Service Code	CPT G0177
Hospital Charge Code	907804065
Hospital Revenue Code	942
Min. Negotiated Rate	$178.75
Max. Negotiated Rate	$243.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$195.00
Rate for Payer: Aetna of CA Government/Medicare	$195.00
Rate for Payer: Cash Price	$146.25
Rate for Payer: Health Smart Auto/Commercial	$195.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$195.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

HC EDUCATION MENTAL HEALTH

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804065
Hospital Revenue Code	912
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$725.00
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cigna of CA HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Heritage Provider Network Commercial	$472.00
Rate for Payer: Heritage Provider Network Senior	$472.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$463.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$522.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Magellan Commercial	$637.00
Rate for Payer: Managed Health Network (MHN) Commercial	$682.00
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	$243.75
Rate for Payer: US Behavioral Health Commercial/Medicare	$498.68

HC EDUCATION MENTAL HEALTH

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804065
Hospital Revenue Code	912
Min. Negotiated Rate	$178.75
Max. Negotiated Rate	$644.00
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cigna of CA HMO/PPO	$260.00
Rate for Payer: Health Smart Auto/Commercial	$195.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Mary Free Bed Workers' Compensation	$644.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

HC EEG,AWAKE/DROWSY

Facility

$2,236.00

Service Code	CPT 95816 TC
Hospital Charge Code	900600228
Hospital Revenue Code	740
Min. Negotiated Rate	$1,229.80
Max. Negotiated Rate	$1,677.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,341.60
Rate for Payer: Aetna of CA Government/Medicare	$1,341.60
Rate for Payer: Cash Price	$1,006.20
Rate for Payer: Health Smart Auto/Commercial	$1,341.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,341.60
Rate for Payer: LLUH Dept of Risk Management WC	$1,229.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,677.00

HC EEG,AWAKE/DROWSY

Facility

$2,236.00

Service Code	CPT 95816
Hospital Charge Code	900600228
Hospital Revenue Code	740
Min. Negotiated Rate	$1,229.80
Max. Negotiated Rate	$1,677.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,341.60
Rate for Payer: Aetna of CA Government/Medicare	$1,341.60
Rate for Payer: Cash Price	$1,006.20
Rate for Payer: Health Smart Auto/Commercial	$1,341.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,341.60
Rate for Payer: LLUH Dept of Risk Management WC	$1,229.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,677.00

HC EEG,AWAKE/DROWSY

Facility

$2,236.00

Service Code	CPT 95816 TC
Hospital Charge Code	900600228
Hospital Revenue Code	740
Min. Negotiated Rate	$1,229.80
Max. Negotiated Rate	$1,788.80
Rate for Payer: Cash Price	$1,006.20
Rate for Payer: Cigna of CA HMO/PPO	$1,788.80
Rate for Payer: Health Smart Auto/Commercial	$1,341.60
Rate for Payer: LLUH Dept of Risk Management WC	$1,229.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,677.00

HC EEG,AWAKE/DROWSY

Facility

$2,236.00

Service Code	CPT 95816
Hospital Charge Code	900600228
Hospital Revenue Code	740
Min. Negotiated Rate	$1,229.80
Max. Negotiated Rate	$1,788.80
Rate for Payer: Cash Price	$1,006.20
Rate for Payer: Cigna of CA HMO/PPO	$1,788.80
Rate for Payer: Health Smart Auto/Commercial	$1,341.60
Rate for Payer: LLUH Dept of Risk Management WC	$1,229.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,677.00

HC ELBOW COMPLETE

Facility

$1,115.00

Service Code	CPT 73080 TC
Hospital Charge Code	909001512
Hospital Revenue Code	320
Min. Negotiated Rate	$613.25
Max. Negotiated Rate	$892.00
Rate for Payer: Cash Price	$501.75
Rate for Payer: Cigna of CA HMO/PPO	$892.00
Rate for Payer: Health Smart Auto/Commercial	$669.00
Rate for Payer: LLUH Dept of Risk Management WC	$613.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$836.25

HC ELBOW COMPLETE

Facility

$1,115.00

Service Code	CPT 73080 TC
Hospital Charge Code	909001512
Hospital Revenue Code	320
Min. Negotiated Rate	$613.25
Max. Negotiated Rate	$836.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$669.00
Rate for Payer: Aetna of CA Government/Medicare	$669.00
Rate for Payer: Cash Price	$501.75
Rate for Payer: Health Smart Auto/Commercial	$669.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$669.00
Rate for Payer: LLUH Dept of Risk Management WC	$613.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$836.25

HC ELBOW COMPLETE

Facility

$1,115.00

Service Code	CPT 73080
Hospital Charge Code	909001512
Hospital Revenue Code	320
Min. Negotiated Rate	$613.25
Max. Negotiated Rate	$836.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$669.00
Rate for Payer: Aetna of CA Government/Medicare	$669.00
Rate for Payer: Cash Price	$501.75
Rate for Payer: Health Smart Auto/Commercial	$669.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$669.00
Rate for Payer: LLUH Dept of Risk Management WC	$613.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$836.25

Know your out-of-pocket cost for care.

All Charges