Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC PHP MURR YOUTH IOP PROCESS

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804362
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 PHP MURR YOUTH IOP STRESS MANAGEMENT

Facility

$262.00

Service Code	CPT 90834
Hospital Charge Code	907804365
Hospital Revenue Code	905
Min. Negotiated Rate	$144.10
Max. Negotiated Rate	$652.36
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$209.60
Rate for Payer: Health Smart Auto/Commercial	$157.20
Rate for Payer: LLUH Dept of Risk Management WC	$144.10
Rate for Payer: Mary Free Bed Workers' Compensation	$652.36
Rate for Payer: Multiplan Commercial	$196.50

HC PHP MURR YOUTH IOP STRESS MANAGEMENT

Facility

$262.00

Service Code	CPT 90834
Hospital Charge Code	907804365
Hospital Revenue Code	905
Min. Negotiated Rate	$144.10
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	$117.90
Rate for Payer: Cash Price	$117.90
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	$144.10
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Multiplan Commercial	$196.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC PHP SHIELD GROUP

Facility

$262.00

Service Code	CPT 90853
Hospital Charge Code	907804377
Hospital Revenue Code	912
Min. Negotiated Rate	$144.10
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$209.60
Rate for Payer: Health Smart Auto/Commercial	$157.20
Rate for Payer: LLUH Dept of Risk Management WC	$144.10
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$196.50

HC PHP SHIELD GROUP

Facility

$262.00

Service Code	CPT 90853
Hospital Charge Code	907804377
Hospital Revenue Code	912
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
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	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$510.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$144.10
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$196.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC PHP WISDOM GROUP

Facility

$301.00

Service Code	CPT 90853
Hospital Charge Code	907804373
Hospital Revenue Code	912
Min. Negotiated Rate	$165.55
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$135.45
Rate for Payer: Cash Price	$135.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$240.80
Rate for Payer: Health Smart Auto/Commercial	$180.60
Rate for Payer: LLUH Dept of Risk Management WC	$165.55
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$225.75

HC PHP WISDOM GROUP

Facility

$301.00

Service Code	CPT 90853
Hospital Charge Code	907804373
Hospital Revenue Code	912
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
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	$135.45
Rate for Payer: Cash Price	$135.45
Rate for Payer: Cash Price	$135.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$510.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$165.55
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$225.75
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC PHP YOUTH-COGNITIVE THERAPY

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804301
Hospital Revenue Code	912
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$703.72
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	$703.72
Rate for Payer: Multiplan Commercial	$280.50

HC PHP YOUTH-COGNITIVE THERAPY

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804301
Hospital Revenue Code	912
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
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	$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	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$510.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
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	$516.13

HC PHP YOUTH COPING RECOVERY

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804300
Hospital Revenue Code	912
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$703.72
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	$703.72
Rate for Payer: Multiplan Commercial	$280.50

HC PHP YOUTH COPING RECOVERY

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804300
Hospital Revenue Code	912
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
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	$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	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$510.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
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	$516.13

HC PHP YOUTH FAMILY THERAPY

Facility

$529.00

Service Code	CPT 90847
Hospital Charge Code	907804316
Hospital Revenue Code	912
Min. Negotiated Rate	$120.20
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
Rate for Payer: Aetna of CA Government/Medicare	$176.80
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	$238.05
Rate for Payer: Cash Price	$238.05
Rate for Payer: Cash Price	$238.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$290.95
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Mary Free Bed Workers' Compensation	$120.20
Rate for Payer: Multiplan Commercial	$396.75
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC PHP YOUTH FAMILY THERAPY

Facility

$529.00

Service Code	CPT 90847
Hospital Charge Code	907804316
Hospital Revenue Code	912
Min. Negotiated Rate	$290.95
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$238.05
Rate for Payer: Cash Price	$238.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$423.20
Rate for Payer: Health Smart Auto/Commercial	$317.40
Rate for Payer: LLUH Dept of Risk Management WC	$290.95
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$396.75

HC PHP YOUTH HEALTH EDUCATION

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804307
Hospital Revenue Code	912
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$703.72
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	$703.72
Rate for Payer: Multiplan Commercial	$280.50

HC PHP YOUTH HEALTH EDUCATION

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804307
Hospital Revenue Code	912
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
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	$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	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$510.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
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	$516.13

HC PHP YOUTH INDIVIDUAL BRIEF

Facility

$262.00

Service Code	CPT 90832
Hospital Charge Code	907804317
Hospital Revenue Code	914
Min. Negotiated Rate	$144.10
Max. Negotiated Rate	$209.60
Rate for Payer: Cash Price	$117.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$209.60
Rate for Payer: Health Smart Auto/Commercial	$157.20
Rate for Payer: LLUH Dept of Risk Management WC	$144.10
Rate for Payer: Multiplan Commercial	$196.50

HC PHP YOUTH INDIVIDUAL BRIEF

Facility

$262.00

Service Code	CPT 90832
Hospital Charge Code	907804317
Hospital Revenue Code	914
Min. Negotiated Rate	$81.95
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	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$209.60
Rate for Payer: Health Smart Auto/Commercial	$157.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$157.20
Rate for Payer: LLUH Dept of Risk Management WC	$144.10
Rate for Payer: Mary Free Bed Workers' Compensation	$81.95
Rate for Payer: Multiplan Commercial	$196.50

HC PHP YOUTH INDIVIDUAL FULL

Facility

$448.00

Service Code	CPT 90834
Hospital Charge Code	907804318
Hospital Revenue Code	912
Min. Negotiated Rate	$149.60
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
Rate for Payer: Aetna of CA Government/Medicare	$149.60
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	$201.60
Rate for Payer: Cash Price	$201.60
Rate for Payer: Cash Price	$201.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$246.40
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Multiplan Commercial	$336.00
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC PHP YOUTH INDIVIDUAL FULL

Facility

$448.00

Service Code	CPT 90834
Hospital Charge Code	907804318
Hospital Revenue Code	912
Min. Negotiated Rate	$246.40
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$201.60
Rate for Payer: Cash Price	$201.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$358.40
Rate for Payer: Health Smart Auto/Commercial	$268.80
Rate for Payer: LLUH Dept of Risk Management WC	$246.40
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$336.00

HC PHP YOUTH IOP COGNITIVE THERAPY

Facility

$262.00

Service Code	CPT 90853
Hospital Charge Code	907804341
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	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
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	$144.10
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	$196.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC PHP YOUTH IOP COGNITIVE THERAPY

Facility

$262.00

Service Code	CPT 90853
Hospital Charge Code	907804341
Hospital Revenue Code	905
Min. Negotiated Rate	$144.10
Max. Negotiated Rate	$652.36
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$209.60
Rate for Payer: Health Smart Auto/Commercial	$157.20
Rate for Payer: LLUH Dept of Risk Management WC	$144.10
Rate for Payer: Mary Free Bed Workers' Compensation	$652.36
Rate for Payer: Multiplan Commercial	$196.50

HC PHP YOUTH IOP COPING RECOVERY

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804340
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 PHP YOUTH IOP COPING RECOVERY

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804340
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 PHP YOUTH IOP FAMILY THERAPY

Facility

$529.00

Service Code	CPT 90847
Hospital Charge Code	907804356
Hospital Revenue Code	905
Min. Negotiated Rate	$290.95
Max. Negotiated Rate	$652.36
Rate for Payer: Cash Price	$238.05
Rate for Payer: Cash Price	$238.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$423.20
Rate for Payer: Health Smart Auto/Commercial	$317.40
Rate for Payer: LLUH Dept of Risk Management WC	$290.95
Rate for Payer: Mary Free Bed Workers' Compensation	$652.36
Rate for Payer: Multiplan Commercial	$396.75

HC PHP YOUTH IOP FAMILY THERAPY

Facility

$529.00

Service Code	CPT 90847
Hospital Charge Code	907804356
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	$238.05
Rate for Payer: Cash Price	$238.05
Rate for Payer: Cash Price	$238.05
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	$290.95
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	$396.75
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

Know your out-of-pocket cost for care.

All Charges