Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC CT HEAD W CONTRAST

Facility

$5,277.00

Service Code	CPT 70460
Hospital Charge Code	909201900
Hospital Revenue Code	351
Min. Negotiated Rate	$2,902.35
Max. Negotiated Rate	$4,221.60
Rate for Payer: Cash Price	$2,374.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4,221.60
Rate for Payer: Health Smart Auto/Commercial	$3,166.20
Rate for Payer: LLUH Dept of Risk Management WC	$2,902.35
Rate for Payer: Multiplan Commercial	$3,957.75

HC CT HEAD W/WO CONTRAS

Facility

$5,482.00

Service Code	CPT 70470
Hospital Charge Code	909201902
Hospital Revenue Code	351
Min. Negotiated Rate	$3,015.10
Max. Negotiated Rate	$4,385.60
Rate for Payer: Cash Price	$2,466.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4,385.60
Rate for Payer: Health Smart Auto/Commercial	$3,289.20
Rate for Payer: LLUH Dept of Risk Management WC	$3,015.10
Rate for Payer: Multiplan Commercial	$4,111.50

HC CT HEAD W/WO CONTRAS

Facility

$3,319.00

Service Code	CPT 70470
Hospital Charge Code	909201902
Hospital Revenue Code	351
Min. Negotiated Rate	$1,825.45
Max. Negotiated Rate	$2,655.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,991.40
Rate for Payer: Aetna of CA Government/Medicare	$1,991.40
Rate for Payer: Cash Price	$1,493.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2,655.20
Rate for Payer: Health Smart Auto/Commercial	$1,991.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,991.40
Rate for Payer: LLUH Dept of Risk Management WC	$1,825.45
Rate for Payer: Multiplan Commercial	$2,489.25

HC CT MAXILLOFAC W CONT

Facility

$2,433.00

Service Code	CPT 70487
Hospital Charge Code	909201907
Hospital Revenue Code	351
Min. Negotiated Rate	$1,338.15
Max. Negotiated Rate	$1,946.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,459.80
Rate for Payer: Aetna of CA Government/Medicare	$1,459.80
Rate for Payer: Cash Price	$1,094.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,946.40
Rate for Payer: Health Smart Auto/Commercial	$1,459.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,459.80
Rate for Payer: LLUH Dept of Risk Management WC	$1,338.15
Rate for Payer: Multiplan Commercial	$1,824.75

HC CT MAXILLOFAC W CONT

Facility

$4,333.00

Service Code	CPT 70487
Hospital Charge Code	909201907
Hospital Revenue Code	351
Min. Negotiated Rate	$2,383.15
Max. Negotiated Rate	$3,466.40
Rate for Payer: Cash Price	$1,949.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3,466.40
Rate for Payer: Health Smart Auto/Commercial	$2,599.80
Rate for Payer: LLUH Dept of Risk Management WC	$2,383.15
Rate for Payer: Multiplan Commercial	$3,249.75

HC CT MAXILLOFAC W/O CO

Facility

$3,783.00

Service Code	CPT 70486
Hospital Charge Code	909201906
Hospital Revenue Code	351
Min. Negotiated Rate	$2,080.65
Max. Negotiated Rate	$3,026.40
Rate for Payer: Cash Price	$1,702.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3,026.40
Rate for Payer: Health Smart Auto/Commercial	$2,269.80
Rate for Payer: LLUH Dept of Risk Management WC	$2,080.65
Rate for Payer: Multiplan Commercial	$2,837.25

HC CT MAXILLOFAC W/O CO

Facility

$2,124.00

Service Code	CPT 70486
Hospital Charge Code	909201906
Hospital Revenue Code	351
Min. Negotiated Rate	$1,168.20
Max. Negotiated Rate	$1,699.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,274.40
Rate for Payer: Aetna of CA Government/Medicare	$1,274.40
Rate for Payer: Cash Price	$955.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,699.20
Rate for Payer: Health Smart Auto/Commercial	$1,274.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,274.40
Rate for Payer: LLUH Dept of Risk Management WC	$1,168.20
Rate for Payer: Multiplan Commercial	$1,593.00

HC CT RECONSTRUCTION

Facility

$70.00

Hospital Charge Code	906901270
Hospital Revenue Code	359
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$56.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$42.00
Rate for Payer: Aetna of CA Government/Medicare	$42.00
Rate for Payer: Cash Price	$31.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$56.00
Rate for Payer: Health Smart Auto/Commercial	$42.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$42.00
Rate for Payer: LLUH Dept of Risk Management WC	$38.50
Rate for Payer: Multiplan Commercial	$52.50

HC CT RECONSTRUCTION

Facility

$70.00

Hospital Charge Code	906901270
Hospital Revenue Code	359
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$56.00
Rate for Payer: Cash Price	$31.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$56.00
Rate for Payer: Health Smart Auto/Commercial	$42.00
Rate for Payer: LLUH Dept of Risk Management WC	$38.50
Rate for Payer: Multiplan Commercial	$52.50

HC CT SOFT TIS NCK W CONTR

Facility

$2,740.00

Service Code	CPT 70491
Hospital Charge Code	909201910
Hospital Revenue Code	351
Min. Negotiated Rate	$1,507.00
Max. Negotiated Rate	$2,192.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,644.00
Rate for Payer: Aetna of CA Government/Medicare	$1,644.00
Rate for Payer: Cash Price	$1,233.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2,192.00
Rate for Payer: Health Smart Auto/Commercial	$1,644.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,644.00
Rate for Payer: LLUH Dept of Risk Management WC	$1,507.00
Rate for Payer: Multiplan Commercial	$2,055.00

HC CT SOFT TIS NCK W CONTR

Facility

$4,882.00

Service Code	CPT 70491
Hospital Charge Code	909201910
Hospital Revenue Code	351
Min. Negotiated Rate	$2,685.10
Max. Negotiated Rate	$3,905.60
Rate for Payer: Cash Price	$2,196.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3,905.60
Rate for Payer: Health Smart Auto/Commercial	$2,929.20
Rate for Payer: LLUH Dept of Risk Management WC	$2,685.10
Rate for Payer: Multiplan Commercial	$3,661.50

HC CT SOFT TIS NCK WO CONTR

Facility

$4,333.00

Service Code	CPT 70490
Hospital Charge Code	909201909
Hospital Revenue Code	351
Min. Negotiated Rate	$2,383.15
Max. Negotiated Rate	$3,466.40
Rate for Payer: Cash Price	$1,949.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3,466.40
Rate for Payer: Health Smart Auto/Commercial	$2,599.80
Rate for Payer: LLUH Dept of Risk Management WC	$2,383.15
Rate for Payer: Multiplan Commercial	$3,249.75

HC CT SOFT TIS NCK WO CONTR

Facility

$2,433.00

Service Code	CPT 70490
Hospital Charge Code	909201909
Hospital Revenue Code	351
Min. Negotiated Rate	$1,338.15
Max. Negotiated Rate	$1,946.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,459.80
Rate for Payer: Aetna of CA Government/Medicare	$1,459.80
Rate for Payer: Cash Price	$1,094.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,946.40
Rate for Payer: Health Smart Auto/Commercial	$1,459.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,459.80
Rate for Payer: LLUH Dept of Risk Management WC	$1,338.15
Rate for Payer: Multiplan Commercial	$1,824.75

HC CT SOFT TISSUE NECK W/WO CNTRST

Facility

$3,266.00

Service Code	CPT 70492
Hospital Charge Code	909201911
Hospital Revenue Code	351
Min. Negotiated Rate	$1,796.30
Max. Negotiated Rate	$2,612.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,959.60
Rate for Payer: Aetna of CA Government/Medicare	$1,959.60
Rate for Payer: Cash Price	$1,469.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2,612.80
Rate for Payer: Health Smart Auto/Commercial	$1,959.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,959.60
Rate for Payer: LLUH Dept of Risk Management WC	$1,796.30
Rate for Payer: Multiplan Commercial	$2,449.50

HC CT SOFT TISSUE NECK W/WO CNTRST

Facility

$4,959.00

Service Code	CPT 70492
Hospital Charge Code	909201911
Hospital Revenue Code	351
Min. Negotiated Rate	$2,727.45
Max. Negotiated Rate	$3,967.20
Rate for Payer: Cash Price	$2,231.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3,967.20
Rate for Payer: Health Smart Auto/Commercial	$2,975.40
Rate for Payer: LLUH Dept of Risk Management WC	$2,727.45
Rate for Payer: Multiplan Commercial	$3,719.25

HC CT TSPINE W W/O CONTRAST

Facility

$5,116.00

Service Code	CPT 72130
Hospital Charge Code	909201966
Hospital Revenue Code	352
Min. Negotiated Rate	$2,813.80
Max. Negotiated Rate	$4,092.80
Rate for Payer: Cash Price	$2,302.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4,092.80
Rate for Payer: Health Smart Auto/Commercial	$3,069.60
Rate for Payer: LLUH Dept of Risk Management WC	$2,813.80
Rate for Payer: Multiplan Commercial	$3,837.00

HC CT TSPINE W W/O CONTRAST

Facility

$3,004.00

Service Code	CPT 72130
Hospital Charge Code	909201966
Hospital Revenue Code	352
Min. Negotiated Rate	$1,652.20
Max. Negotiated Rate	$2,403.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,802.40
Rate for Payer: Aetna of CA Government/Medicare	$1,802.40
Rate for Payer: Cash Price	$1,351.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2,403.20
Rate for Payer: Health Smart Auto/Commercial	$1,802.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,802.40
Rate for Payer: LLUH Dept of Risk Management WC	$1,652.20
Rate for Payer: Multiplan Commercial	$2,253.00

HC CULTURE AEROBIC ID

Facility

$200.00

Service Code	CPT 87077
Hospital Charge Code	900911554
Hospital Revenue Code	306
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$160.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$160.00
Rate for Payer: Health Smart Auto/Commercial	$120.00
Rate for Payer: LLUH Dept of Risk Management WC	$110.00
Rate for Payer: Multiplan Commercial	$150.00

HC CULTURE AEROBIC ID

Facility

$62.00

Service Code	CPT 87077
Hospital Charge Code	900911554
Hospital Revenue Code	306
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$49.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$37.20
Rate for Payer: Aetna of CA Government/Medicare	$37.20
Rate for Payer: Cash Price	$27.90
Rate for Payer: Cash Price	$27.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$49.60
Rate for Payer: Health Smart Auto/Commercial	$37.20
Rate for Payer: Intervalley Health Plan Commercial	$8.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$37.20
Rate for Payer: LLUH Dept of Risk Management WC	$34.10
Rate for Payer: Multiplan Commercial	$46.50

HC CULTURE ANAEROBIC

Facility

$82.00

Service Code	CPT 87075
Hospital Charge Code	900911501
Hospital Revenue Code	306
Min. Negotiated Rate	$9.47
Max. Negotiated Rate	$65.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$49.20
Rate for Payer: Aetna of CA Government/Medicare	$49.20
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cash Price	$36.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$65.60
Rate for Payer: Health Smart Auto/Commercial	$49.20
Rate for Payer: Intervalley Health Plan Commercial	$9.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$49.20
Rate for Payer: LLUH Dept of Risk Management WC	$45.10
Rate for Payer: Multiplan Commercial	$61.50

HC CULTURE ANAEROBIC

Facility

$347.00

Service Code	CPT 87075
Hospital Charge Code	900911501
Hospital Revenue Code	306
Min. Negotiated Rate	$190.85
Max. Negotiated Rate	$277.60
Rate for Payer: Cash Price	$156.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$277.60
Rate for Payer: Health Smart Auto/Commercial	$208.20
Rate for Payer: LLUH Dept of Risk Management WC	$190.85
Rate for Payer: Multiplan Commercial	$260.25

HC CULTURE ANAEROBIC IDS RAPID

Facility

$200.00

Service Code	CPT 87076
Hospital Charge Code	900911553
Hospital Revenue Code	306
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$160.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$160.00
Rate for Payer: Health Smart Auto/Commercial	$120.00
Rate for Payer: LLUH Dept of Risk Management WC	$110.00
Rate for Payer: Multiplan Commercial	$150.00

HC CULTURE ANAEROBIC IDS RAPID

Facility

$72.00

Service Code	CPT 87076
Hospital Charge Code	900911553
Hospital Revenue Code	306
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$43.20
Rate for Payer: Aetna of CA Government/Medicare	$43.20
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$57.60
Rate for Payer: Health Smart Auto/Commercial	$43.20
Rate for Payer: Intervalley Health Plan Commercial	$8.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$43.20
Rate for Payer: LLUH Dept of Risk Management WC	$39.60
Rate for Payer: Multiplan Commercial	$54.00

HC CULTURE BACTERIAL AG H INFLU

Facility

$132.00

Service Code	CPT 87147
Hospital Charge Code	900911711
Hospital Revenue Code	306
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$105.60
Rate for Payer: Cash Price	$59.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$105.60
Rate for Payer: Health Smart Auto/Commercial	$79.20
Rate for Payer: LLUH Dept of Risk Management WC	$72.60
Rate for Payer: Multiplan Commercial	$99.00

HC CULTURE BACTERIAL AG H INFLU

Facility

$46.00

Service Code	CPT 87147
Hospital Charge Code	900911711
Hospital Revenue Code	306
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$36.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.60
Rate for Payer: Aetna of CA Government/Medicare	$27.60
Rate for Payer: Cash Price	$20.70
Rate for Payer: Cash Price	$20.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$36.80
Rate for Payer: Health Smart Auto/Commercial	$27.60
Rate for Payer: Intervalley Health Plan Commercial	$5.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.60
Rate for Payer: LLUH Dept of Risk Management WC	$25.30
Rate for Payer: Multiplan Commercial	$34.50

Know your out-of-pocket cost for care.

All Charges