Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC IOP COPING SKILLS

Facility

$325.00

Service Code	CPT G0411
Hospital Charge Code	907804060
Hospital Revenue Code	905
Min. Negotiated Rate	$178.75
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$475.00
Rate for Payer: Anthem Blue Cross of CA Commercial/Medicare	$295.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Caremore Medicare Advantage	$401.00
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	$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	$178.75
Rate for Payer: Magellan Commercial	$406.00
Rate for Payer: Managed Health Network (MHN) Commercial	$434.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75
Rate for Payer: US Behavioral Health Commercial/Medicare	$397.33

HC IOP COPING SKILLS

Facility

$325.00

Service Code	CPT G0411
Hospital Charge Code	907804060
Hospital Revenue Code	905
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	$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	$469.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

HC IOP ED COGNITIVE THERAPY

Facility

$335.00

Service Code	CPT G0411
Hospital Charge Code	907804141
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 IOP ED COGNITIVE THERAPY

Facility

$335.00

Service Code	CPT 90853
Hospital Charge Code	907804141
Hospital Revenue Code	905
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	$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: Mary Free Bed Workers' Compensation	$469.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$251.25

HC IOP ED COGNITIVE THERAPY

Facility

$335.00

Service Code	CPT 90853
Hospital Charge Code	907804141
Hospital Revenue Code	905
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$475.00
Rate for Payer: Anthem Blue Cross of CA Commercial/Medicare	$358.00
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	$150.75
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	$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	$184.25
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	$251.25
Rate for Payer: US Behavioral Health Commercial/Medicare	$397.33

HC IOP ED COGNITIVE THERAPY

Facility

$335.00

Service Code	CPT G0411
Hospital Charge Code	907804141
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 IOP ED COPING SKILLS

Facility

$335.00

Service Code	CPT 90853
Hospital Charge Code	907804140
Hospital Revenue Code	905
Min. Negotiated Rate	$184.25
Max. Negotiated Rate	$469.00
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	$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: Mary Free Bed Workers' Compensation	$469.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$251.25

HC IOP ED COPING SKILLS

Facility

$335.00

Service Code	CPT G0411
Hospital Charge Code	907804140
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 IOP ED COPING SKILLS

Facility

$335.00

Service Code	CPT G0411
Hospital Charge Code	907804140
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 IOP ED COPING SKILLS

Facility

$335.00

Service Code	CPT 90853
Hospital Charge Code	907804140
Hospital Revenue Code	905
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$475.00
Rate for Payer: Anthem Blue Cross of CA Commercial/Medicare	$358.00
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	$150.75
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	$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	$184.25
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	$251.25
Rate for Payer: US Behavioral Health Commercial/Medicare	$397.33

HC IOP ED FAMILY THERAPY W PATIENT

Facility

$460.00

Service Code	CPT 90847
Hospital Charge Code	907804156
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: 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 IOP ED FAMILY THERAPY W PATIENT

Facility

$460.00

Service Code	CPT 90847
Hospital Charge Code	907804156
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: Anthem Blue Cross of CA Commercial/Medicare	$358.00
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: 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 IOP ED INDIV THERAPY

Facility

$425.00

Service Code	CPT 90834
Hospital Charge Code	907804158
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: Anthem Blue Cross of CA Commercial/Medicare	$358.00
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: 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 IOP ED INDIV THERAPY

Facility

$425.00

Service Code	CPT 90834
Hospital Charge Code	907804158
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: 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 IOP ED PROCESS GROUP

Facility

$335.00

Service Code	CPT G0411
Hospital Charge Code	907804142
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 IOP ED PROCESS GROUP

Facility

$335.00

Service Code	CPT 90853
Hospital Charge Code	907804142
Hospital Revenue Code	905
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$475.00
Rate for Payer: Anthem Blue Cross of CA Commercial/Medicare	$358.00
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	$150.75
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	$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	$184.25
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	$251.25
Rate for Payer: US Behavioral Health Commercial/Medicare	$397.33

HC IOP ED PROCESS GROUP

Facility

$335.00

Service Code	CPT G0411
Hospital Charge Code	907804142
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 IOP ED PROCESS GROUP

Facility

$335.00

Service Code	CPT 90853
Hospital Charge Code	907804142
Hospital Revenue Code	905
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	$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: Mary Free Bed Workers' Compensation	$469.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$251.25

HC IOP OT TASK GROUP

Facility

$208.00

Service Code	CPT G0177
Hospital Charge Code	907804067
Hospital Revenue Code	942
Min. Negotiated Rate	$114.40
Max. Negotiated Rate	$166.40
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cigna of CA HMO/PPO	$166.40
Rate for Payer: Health Smart Auto/Commercial	$124.80
Rate for Payer: LLUH Dept of Risk Management WC	$114.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$156.00

HC IOP OT TASK GROUP

Facility

$208.00

Service Code	CPT 90853
Hospital Charge Code	907804067
Hospital Revenue Code	905
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$475.00
Rate for Payer: Anthem Blue Cross of CA Commercial/Medicare	$295.00
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	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
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	$114.40
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	$156.00
Rate for Payer: US Behavioral Health Commercial/Medicare	$397.33

HC IOP OT TASK GROUP

Facility

$208.00

Service Code	CPT G0177
Hospital Charge Code	907804067
Hospital Revenue Code	942
Min. Negotiated Rate	$114.40
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$124.80
Rate for Payer: Aetna of CA Government/Medicare	$124.80
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Smart Auto/Commercial	$124.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$124.80
Rate for Payer: LLUH Dept of Risk Management WC	$114.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$156.00

HC IOP OT TASK GROUP

Facility

$208.00

Service Code	CPT 90853
Hospital Charge Code	907804067
Hospital Revenue Code	905
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cigna of CA HMO/PPO	$166.40
Rate for Payer: Health Smart Auto/Commercial	$124.80
Rate for Payer: LLUH Dept of Risk Management WC	$114.40
Rate for Payer: Mary Free Bed Workers' Compensation	$469.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$156.00

HC IOP PROCESS GROUP

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804062
Hospital Revenue Code	905
Min. Negotiated Rate	$178.75
Max. Negotiated Rate	$469.00
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	$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	$469.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

HC IOP PROCESS GROUP

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804062
Hospital Revenue Code	905
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$475.00
Rate for Payer: Anthem Blue Cross of CA Commercial/Medicare	$295.00
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	$146.25
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	$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	$178.75
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	$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	$397.33

HC IOP PROCESS GROUP

Facility

$325.00

Service Code	CPT G0411
Hospital Charge Code	907804062
Hospital Revenue Code	915
Min. Negotiated Rate	$178.75
Max. Negotiated Rate	$400.00
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: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Cash Price	$146.25
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

Know your out-of-pocket cost for care.

All Charges