Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC PHOSPHOROUS URINE

Facility

$20.00

Service Code	CPT 84105
Hospital Charge Code	900910215
Hospital Revenue Code	301
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 PHOSPHORUS

Facility

$156.00

Service Code	CPT 84100
Hospital Charge Code	900910252
Hospital Revenue Code	301
Min. Negotiated Rate	$85.80
Max. Negotiated Rate	$124.80
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cigna of CA HMO/PPO	$124.80
Rate for Payer: Health Smart Auto/Commercial	$93.60
Rate for Payer: LLUH Dept of Risk Management WC	$85.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$117.00

HC PHOSPHORUS

Facility

$15.00

Service Code	CPT 84100
Hospital Charge Code	900910252
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.00
Rate for Payer: Aetna of CA Government/Medicare	$9.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC PHP COGNITIVE THERAPY

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804001
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: Anthem Blue Cross of CA Commercial/Medicare	$439.00
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: 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 PHP COGNITIVE THERAPY

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804001
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: 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 PHP COGNITIVE THERAPY

Facility

$325.00

Service Code	CPT G0411
Hospital Charge Code	907804001
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

HC PHP COGNITIVE THERAPY

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804001
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	$146.25
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: Mary Free Bed Workers' Compensation	$41.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

HC PHP COGNITIVE THERAPY

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804001
Hospital Revenue Code	915
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 PHP COGNITIVE THERAPY

Facility

$325.00

Service Code	CPT G0411
Hospital Charge Code	907804001
Hospital Revenue Code	915
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 PHP ED PROCESS GROUP

Facility

$335.00

Service Code	CPT G0411
Hospital Charge Code	907804102
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 PHP ED PROCESS GROUP

Facility

$335.00

Service Code	CPT 90853
Hospital Charge Code	907804102
Hospital Revenue Code	912
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$725.00
Rate for Payer: Magellan Commercial	$637.00
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: Anthem Blue Cross of CA Commercial/Medicare	$667.00
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: 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: 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 PHP ED PROCESS GROUP

Facility

$335.00

Service Code	CPT G0411
Hospital Charge Code	907804102
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 PHP ED PROCESS GROUP

Facility

$335.00

Service Code	CPT 90853
Hospital Charge Code	907804102
Hospital Revenue Code	912
Min. Negotiated Rate	$184.25
Max. Negotiated Rate	$597.00
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	$597.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$251.25

HC PHP WISDOM GROUP

Facility

$228.00

Service Code	CPT 90853
Hospital Charge Code	907804373
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: Anthem Blue Cross of CA Commercial/Medicare	$439.00
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	$102.60
Rate for Payer: Cash Price	$102.60
Rate for Payer: Cash Price	$102.60
Rate for Payer: Cash Price	$102.60
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	$125.40
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	$171.00
Rate for Payer: US Behavioral Health Commercial/Medicare	$498.68

HC PHP WISDOM GROUP

Facility

$228.00

Service Code	CPT 90853
Hospital Charge Code	907804373
Hospital Revenue Code	912
Rate for Payer: Cash Price	$102.60
Rate for Payer: Cash Price	$102.60
Rate for Payer: Cash Price	$102.60
Rate for Payer: Cigna of CA HMO/PPO	$182.40
Rate for Payer: Health Smart Auto/Commercial	$136.80
Rate for Payer: LLUH Dept of Risk Management WC	$125.40
Rate for Payer: Mary Free Bed Workers' Compensation	$644.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$171.00

HC PHP WISDOM GROUP

Facility

$228.00

Service Code	CPT G0411
Hospital Charge Code	907804373
Hospital Revenue Code	915
Min. Negotiated Rate	$125.40
Max. Negotiated Rate	$182.40
Rate for Payer: Cash Price	$102.60
Rate for Payer: Cigna of CA HMO/PPO	$182.40
Rate for Payer: Health Smart Auto/Commercial	$136.80
Rate for Payer: LLUH Dept of Risk Management WC	$125.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$171.00

HC PHP WISDOM GROUP

Facility

$228.00

Service Code	CPT G0411
Hospital Charge Code	907804373
Hospital Revenue Code	915
Min. Negotiated Rate	$125.40
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$136.80
Rate for Payer: Aetna of CA Government/Medicare	$136.80
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Cash Price	$102.60
Rate for Payer: Cash Price	$102.60
Rate for Payer: Health Smart Auto/Commercial	$136.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$136.80
Rate for Payer: LLUH Dept of Risk Management WC	$125.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$171.00

HC PI-LINKD AG, FLOW 1ST MRKR WBC

Facility

$451.00

Service Code	CPT 88184 90
Hospital Charge Code	900914174
Hospital Revenue Code	301
Min. Negotiated Rate	$248.05
Max. Negotiated Rate	$360.80
Rate for Payer: Cash Price	$202.95
Rate for Payer: Cigna of CA HMO/PPO	$360.80
Rate for Payer: Health Smart Auto/Commercial	$270.60
Rate for Payer: LLUH Dept of Risk Management WC	$248.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$338.25

HC PI-LINKD AG, FLOW 1ST MRKR WBC

Facility

$451.00

Service Code	CPT 88184
Hospital Charge Code	900914174
Hospital Revenue Code	309
Min. Negotiated Rate	$248.05
Max. Negotiated Rate	$360.80
Rate for Payer: Cash Price	$202.95
Rate for Payer: Cigna of CA HMO/PPO	$360.80
Rate for Payer: Health Smart Auto/Commercial	$270.60
Rate for Payer: LLUH Dept of Risk Management WC	$248.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$338.25

HC PI-LINKD AG, FLOW 1ST MRKR WBC

Facility

$451.00

Service Code	CPT 88184
Hospital Charge Code	900914174
Hospital Revenue Code	309
Min. Negotiated Rate	$248.05
Max. Negotiated Rate	$338.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$270.60
Rate for Payer: Aetna of CA Government/Medicare	$270.60
Rate for Payer: Cash Price	$202.95
Rate for Payer: Health Smart Auto/Commercial	$270.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$270.60
Rate for Payer: LLUH Dept of Risk Management WC	$248.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$338.25

HC PI-LINKD AG, FLOW 1ST MRKR WBC

Facility

$451.00

Service Code	CPT 88184 90
Hospital Charge Code	900914174
Hospital Revenue Code	301
Min. Negotiated Rate	$248.05
Max. Negotiated Rate	$338.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$270.60
Rate for Payer: Aetna of CA Government/Medicare	$270.60
Rate for Payer: Cash Price	$202.95
Rate for Payer: Health Smart Auto/Commercial	$270.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$270.60
Rate for Payer: LLUH Dept of Risk Management WC	$248.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$338.25

HC PI-LINKD AG,FLOW ADD'L MRKR,WBC

Facility

$36.00

Service Code	CPT 88185 90
Hospital Charge Code	900914175
Hospital Revenue Code	301
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$28.80
Rate for Payer: Cash Price	$16.20
Rate for Payer: Cigna of CA HMO/PPO	$28.80
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.00

HC PI-LINKD AG,FLOW ADD'L MRKR,WBC

Facility

$36.00

Service Code	CPT 88185 90
Hospital Charge Code	900914175
Hospital Revenue Code	301
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.60
Rate for Payer: Aetna of CA Government/Medicare	$21.60
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.00

HC PI-LINKD AG,FLOW ADD'L MRKR,WBC

Facility

$36.00

Service Code	CPT 88185
Hospital Charge Code	900914175
Hospital Revenue Code	309
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$28.80
Rate for Payer: Cash Price	$16.20
Rate for Payer: Cigna of CA HMO/PPO	$28.80
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.00

HC PI-LINKD AG,FLOW ADD'L MRKR,WBC

Facility

$36.00

Service Code	CPT 88185
Hospital Charge Code	900914175
Hospital Revenue Code	309
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.60
Rate for Payer: Aetna of CA Government/Medicare	$21.60
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.00

Know your out-of-pocket cost for care.

All Charges