Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC PHP YOUTH IOP HEALTH EDUCATION

Facility

$262.00

Service Code	CPT 90853
Hospital Charge Code	907804347
Hospital Revenue Code	942
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 IOP HEALTH EDUCATION

Facility

$262.00

Service Code	CPT 90853
Hospital Charge Code	907804347
Hospital Revenue Code	942
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$209.60
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	$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	$44.80
Rate for Payer: Multiplan Commercial	$196.50

HC PHP YOUTH IOP INDIVIDUAL BRIEF

Facility

$374.00

Service Code	CPT 90832
Hospital Charge Code	907804357
Hospital Revenue Code	914
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$299.20
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: Multiplan Commercial	$280.50

HC PHP YOUTH IOP INDIVIDUAL BRIEF

Facility

$374.00

Service Code	CPT 90832
Hospital Charge Code	907804357
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	$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	$299.20
Rate for Payer: Health Smart Auto/Commercial	$224.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$224.40
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Mary Free Bed Workers' Compensation	$81.95
Rate for Payer: Multiplan Commercial	$280.50

HC PHP YOUTH IOP INDIVIDUAL FULL

Facility

$448.00

Service Code	CPT 90834
Hospital Charge Code	907804358
Hospital Revenue Code	905
Min. Negotiated Rate	$246.40
Max. Negotiated Rate	$652.36
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	$652.36
Rate for Payer: Multiplan Commercial	$336.00

HC PHP YOUTH IOP INDIVIDUAL FULL

Facility

$448.00

Service Code	CPT 90834
Hospital Charge Code	907804358
Hospital Revenue Code	905
Min. Negotiated Rate	$246.40
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	$201.60
Rate for Payer: Cash Price	$201.60
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	$246.40
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Multiplan Commercial	$336.00
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC PHP YOUTH IOP MENTAL HEALTH ED

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804346
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 MENTAL HEALTH ED

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804346
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 MULTI FAMILY

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804359
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 MULTI FAMILY

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804359
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 OCCUPATIONAL THERAPY

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804355
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 OCCUPATIONAL THERAPY

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804355
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 PROCESS

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804342
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 PROCESS

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804342
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 STRESS MANAGEMENT

Facility

$262.00

Service Code	CPT 90834
Hospital Charge Code	907804348
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 STRESS MANAGEMENT

Facility

$262.00

Service Code	CPT 90834
Hospital Charge Code	907804348
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 YOUTH MENTAL HEALTH ED

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804306
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 MENTAL HEALTH ED

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804306
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 MULTI FAMILY

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804319
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 MULTI FAMILY

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804319
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 OCCUPATIONAL THERAPY

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804315
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 OCCUPATIONAL THERAPY

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804315
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 PROCESS

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804302
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 PROCESS

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804302
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 STRESS MANAGEMENT

Facility

$402.00

Service Code	CPT 90834
Hospital Charge Code	907804308
Hospital Revenue Code	912
Min. Negotiated Rate	$221.10
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$180.90
Rate for Payer: Cash Price	$180.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$321.60
Rate for Payer: Health Smart Auto/Commercial	$241.20
Rate for Payer: LLUH Dept of Risk Management WC	$221.10
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$301.50

Know your out-of-pocket cost for care.

All Charges