Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC CREATININE BODY FLUID

Facility

$115.00

Service Code	CPT 82570
Hospital Charge Code	900910377
Hospital Revenue Code	301
Min. Negotiated Rate	$63.25
Max. Negotiated Rate	$92.00
Rate for Payer: Cash Price	$51.75
Rate for Payer: Cigna of CA HMO/PPO	$92.00
Rate for Payer: Health Smart Auto/Commercial	$69.00
Rate for Payer: LLUH Dept of Risk Management WC	$63.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$86.25

HC CREATININE CLEARAN

Facility

$236.00

Service Code	CPT 82575
Hospital Charge Code	900910260
Hospital Revenue Code	301
Min. Negotiated Rate	$129.80
Max. Negotiated Rate	$188.80
Rate for Payer: Cash Price	$106.20
Rate for Payer: Cigna of CA HMO/PPO	$188.80
Rate for Payer: Health Smart Auto/Commercial	$141.60
Rate for Payer: LLUH Dept of Risk Management WC	$129.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$177.00

HC CREATININE CLEARAN

Facility

$36.00

Service Code	CPT 82575
Hospital Charge Code	900910260
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 CREATININE INDIVIDUAL

Facility

$89.00

Service Code	CPT 82565
Hospital Charge Code	900910493
Hospital Revenue Code	301
Min. Negotiated Rate	$48.95
Max. Negotiated Rate	$71.20
Rate for Payer: Cash Price	$40.05
Rate for Payer: Cigna of CA HMO/PPO	$71.20
Rate for Payer: Health Smart Auto/Commercial	$53.40
Rate for Payer: LLUH Dept of Risk Management WC	$48.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$66.75

HC CREATININE INDIVIDUAL

Facility

$15.00

Service Code	CPT 82565
Hospital Charge Code	900910493
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 CRYOGLOBULINS QUAL

Facility

$138.00

Service Code	CPT 82595
Hospital Charge Code	900910978
Hospital Revenue Code	301
Min. Negotiated Rate	$75.90
Max. Negotiated Rate	$110.40
Rate for Payer: Cash Price	$62.10
Rate for Payer: Cigna of CA HMO/PPO	$110.40
Rate for Payer: Health Smart Auto/Commercial	$82.80
Rate for Payer: LLUH Dept of Risk Management WC	$75.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$103.50

HC CRYOGLOBULINS QUAL

Facility

$21.00

Service Code	CPT 82595
Hospital Charge Code	900910978
Hospital Revenue Code	301
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$15.75
Rate for Payer: Health Smart Auto/Commercial	$12.60
Rate for Payer: Cash Price	$9.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.60
Rate for Payer: Aetna of CA Government/Medicare	$12.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.60
Rate for Payer: LLUH Dept of Risk Management WC	$11.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.75

HC CT ABDOMEN & PELVIS W & W/O CO

Facility

$9,023.00

Service Code	CPT 74178
Hospital Charge Code	909202003
Hospital Revenue Code	352
Min. Negotiated Rate	$4,962.65
Max. Negotiated Rate	$7,218.40
Rate for Payer: Cash Price	$4,060.35
Rate for Payer: Cigna of CA HMO/PPO	$7,218.40
Rate for Payer: Health Smart Auto/Commercial	$5,413.80
Rate for Payer: LLUH Dept of Risk Management WC	$4,962.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6,767.25

HC CT ABDOMEN & PELVIS W & W/O CO

Facility

$9,023.00

Service Code	CPT 74178 TC
Hospital Charge Code	909202003
Hospital Revenue Code	352
Min. Negotiated Rate	$4,962.65
Max. Negotiated Rate	$7,218.40
Rate for Payer: Cash Price	$4,060.35
Rate for Payer: Cigna of CA HMO/PPO	$7,218.40
Rate for Payer: Health Smart Auto/Commercial	$5,413.80
Rate for Payer: LLUH Dept of Risk Management WC	$4,962.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6,767.25

HC CT ABDOMEN & PELVIS W & W/O CO

Facility

$5,066.00

Service Code	CPT 74178
Hospital Charge Code	909202003
Hospital Revenue Code	352
Min. Negotiated Rate	$2,786.30
Max. Negotiated Rate	$3,799.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3,039.60
Rate for Payer: Aetna of CA Government/Medicare	$3,039.60
Rate for Payer: Cash Price	$2,279.70
Rate for Payer: Health Smart Auto/Commercial	$3,039.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3,039.60
Rate for Payer: LLUH Dept of Risk Management WC	$2,786.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3,799.50

HC CT ABDOMEN WO CONTR

Facility

$5,637.00

Service Code	CPT 74150 TC
Hospital Charge Code	909201927
Hospital Revenue Code	352
Min. Negotiated Rate	$3,100.35
Max. Negotiated Rate	$4,509.60
Rate for Payer: Cash Price	$2,536.65
Rate for Payer: Cigna of CA HMO/PPO	$4,509.60
Rate for Payer: Health Smart Auto/Commercial	$3,382.20
Rate for Payer: LLUH Dept of Risk Management WC	$3,100.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4,227.75

HC CT ABDOMEN WO CONTR

Facility

$5,637.00

Service Code	CPT 74150
Hospital Charge Code	909201927
Hospital Revenue Code	352
Min. Negotiated Rate	$3,100.35
Max. Negotiated Rate	$4,509.60
Rate for Payer: Cash Price	$2,536.65
Rate for Payer: Cigna of CA HMO/PPO	$4,509.60
Rate for Payer: Health Smart Auto/Commercial	$3,382.20
Rate for Payer: LLUH Dept of Risk Management WC	$3,100.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4,227.75

HC CT ABDOMEN WO CONTR

Facility

$3,135.00

Service Code	CPT 74150
Hospital Charge Code	909201927
Hospital Revenue Code	352
Min. Negotiated Rate	$1,724.25
Max. Negotiated Rate	$2,351.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,881.00
Rate for Payer: Aetna of CA Government/Medicare	$1,881.00
Rate for Payer: Cash Price	$1,410.75
Rate for Payer: Health Smart Auto/Commercial	$1,881.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,881.00
Rate for Payer: LLUH Dept of Risk Management WC	$1,724.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,351.25

HC CT ABDOMEN W/WO CONT

Facility

$7,345.00

Service Code	CPT 74170 TC
Hospital Charge Code	909201929
Hospital Revenue Code	352
Min. Negotiated Rate	$4,039.75
Max. Negotiated Rate	$5,876.00
Rate for Payer: Cash Price	$3,305.25
Rate for Payer: Cigna of CA HMO/PPO	$5,876.00
Rate for Payer: Health Smart Auto/Commercial	$4,407.00
Rate for Payer: LLUH Dept of Risk Management WC	$4,039.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5,508.75

HC CT ABDOMEN W/WO CONT

Facility

$7,345.00

Service Code	CPT 74170
Hospital Charge Code	909201929
Hospital Revenue Code	352
Min. Negotiated Rate	$4,039.75
Max. Negotiated Rate	$5,876.00
Rate for Payer: Cash Price	$3,305.25
Rate for Payer: Cigna of CA HMO/PPO	$5,876.00
Rate for Payer: Health Smart Auto/Commercial	$4,407.00
Rate for Payer: LLUH Dept of Risk Management WC	$4,039.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5,508.75

HC CT ABDOMEN W/WO CONT

Facility

$4,124.00

Service Code	CPT 74170
Hospital Charge Code	909201929
Hospital Revenue Code	352
Min. Negotiated Rate	$2,268.20
Max. Negotiated Rate	$3,093.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2,474.40
Rate for Payer: Aetna of CA Government/Medicare	$2,474.40
Rate for Payer: Cash Price	$1,855.80
Rate for Payer: Health Smart Auto/Commercial	$2,474.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2,474.40
Rate for Payer: LLUH Dept of Risk Management WC	$2,268.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3,093.00

HC CT BONE PELVIS W CONTRAST

Facility

$5,786.00

Service Code	CPT 72193 TC
Hospital Charge Code	909201931
Hospital Revenue Code	352
Min. Negotiated Rate	$3,182.30
Max. Negotiated Rate	$4,628.80
Rate for Payer: Cash Price	$2,603.70
Rate for Payer: Cigna of CA HMO/PPO	$4,628.80
Rate for Payer: Health Smart Auto/Commercial	$3,471.60
Rate for Payer: LLUH Dept of Risk Management WC	$3,182.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4,339.50

HC CT BONE PELVIS W CONTRAST

Facility

$3,248.00

Service Code	CPT 72193
Hospital Charge Code	909201931
Hospital Revenue Code	352
Min. Negotiated Rate	$1,786.40
Max. Negotiated Rate	$2,436.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,948.80
Rate for Payer: Aetna of CA Government/Medicare	$1,948.80
Rate for Payer: Cash Price	$1,461.60
Rate for Payer: Health Smart Auto/Commercial	$1,948.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,948.80
Rate for Payer: LLUH Dept of Risk Management WC	$1,786.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,436.00

HC CT BONE PELVIS W CONTRAST

Facility

$5,786.00

Service Code	CPT 72193
Hospital Charge Code	909201931
Hospital Revenue Code	352
Min. Negotiated Rate	$3,182.30
Max. Negotiated Rate	$4,628.80
Rate for Payer: Cash Price	$2,603.70
Rate for Payer: Cigna of CA HMO/PPO	$4,628.80
Rate for Payer: Health Smart Auto/Commercial	$3,471.60
Rate for Payer: LLUH Dept of Risk Management WC	$3,182.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4,339.50

HC CT BONE PELVIS W/O CONTRAST

Facility

$2,989.00

Service Code	CPT 72192
Hospital Charge Code	909201930
Hospital Revenue Code	352
Min. Negotiated Rate	$1,643.95
Max. Negotiated Rate	$2,241.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,793.40
Rate for Payer: Aetna of CA Government/Medicare	$1,793.40
Rate for Payer: Cash Price	$1,345.05
Rate for Payer: Health Smart Auto/Commercial	$1,793.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,793.40
Rate for Payer: LLUH Dept of Risk Management WC	$1,643.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,241.75

HC CT BONE PELVIS W/O CONTRAST

Facility

$5,324.00

Service Code	CPT 72192 TC
Hospital Charge Code	909201930
Hospital Revenue Code	352
Min. Negotiated Rate	$2,928.20
Max. Negotiated Rate	$4,259.20
Rate for Payer: Cash Price	$2,395.80
Rate for Payer: Cigna of CA HMO/PPO	$4,259.20
Rate for Payer: Health Smart Auto/Commercial	$3,194.40
Rate for Payer: LLUH Dept of Risk Management WC	$2,928.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3,993.00

HC CT BONE PELVIS W/O CONTRAST

Facility

$5,324.00

Service Code	CPT 72192
Hospital Charge Code	909201930
Hospital Revenue Code	352
Min. Negotiated Rate	$2,928.20
Max. Negotiated Rate	$4,259.20
Rate for Payer: Cash Price	$2,395.80
Rate for Payer: Cigna of CA HMO/PPO	$4,259.20
Rate for Payer: Health Smart Auto/Commercial	$3,194.40
Rate for Payer: LLUH Dept of Risk Management WC	$2,928.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3,993.00

HC CT BONE PELVIS W/WO CONTRAST

Facility

$6,324.00

Service Code	CPT 72194
Hospital Charge Code	909201932
Hospital Revenue Code	352
Min. Negotiated Rate	$3,478.20
Max. Negotiated Rate	$5,059.20
Rate for Payer: Cash Price	$2,845.80
Rate for Payer: Cigna of CA HMO/PPO	$5,059.20
Rate for Payer: Health Smart Auto/Commercial	$3,794.40
Rate for Payer: LLUH Dept of Risk Management WC	$3,478.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4,743.00

HC CT BONE PELVIS W/WO CONTRAST

Facility

$3,550.00

Service Code	CPT 72194
Hospital Charge Code	909201932
Hospital Revenue Code	352
Min. Negotiated Rate	$1,952.50
Max. Negotiated Rate	$2,662.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2,130.00
Rate for Payer: Aetna of CA Government/Medicare	$2,130.00
Rate for Payer: Cash Price	$1,597.50
Rate for Payer: Health Smart Auto/Commercial	$2,130.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2,130.00
Rate for Payer: LLUH Dept of Risk Management WC	$1,952.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,662.50

HC CT BONE PELVIS W/WO CONTRAST

Facility

$6,324.00

Service Code	CPT 72194 TC
Hospital Charge Code	909201932
Hospital Revenue Code	352
Min. Negotiated Rate	$3,478.20
Max. Negotiated Rate	$5,059.20
Rate for Payer: Cash Price	$2,845.80
Rate for Payer: Cigna of CA HMO/PPO	$5,059.20
Rate for Payer: Health Smart Auto/Commercial	$3,794.40
Rate for Payer: LLUH Dept of Risk Management WC	$3,478.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4,743.00

Know your out-of-pocket cost for care.

All Charges