Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC CT CHEST W CONTRAST

Facility

$3,248.00

Service Code	CPT 71260
Hospital Charge Code	909201913
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 CHEST W CONTRAST

Facility

$5,786.00

Service Code	CPT 71260 TC
Hospital Charge Code	909201913
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 CHEST W CONTRAST

Facility

$5,786.00

Service Code	CPT 71260
Hospital Charge Code	909201913
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 CHEST W/O CONTRAST

Facility

$4,712.00

Service Code	CPT 71250 TC
Hospital Charge Code	909201912
Hospital Revenue Code	352
Min. Negotiated Rate	$2,591.60
Max. Negotiated Rate	$3,769.60
Rate for Payer: Cash Price	$2,120.40
Rate for Payer: Cigna of CA HMO/PPO	$3,769.60
Rate for Payer: Health Smart Auto/Commercial	$2,827.20
Rate for Payer: LLUH Dept of Risk Management WC	$2,591.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3,534.00

HC CT CHEST W/O CONTRAST

Facility

$2,645.00

Service Code	CPT 71250
Hospital Charge Code	909201912
Hospital Revenue Code	352
Min. Negotiated Rate	$1,454.75
Max. Negotiated Rate	$1,983.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,587.00
Rate for Payer: Aetna of CA Government/Medicare	$1,587.00
Rate for Payer: Cash Price	$1,190.25
Rate for Payer: Health Smart Auto/Commercial	$1,587.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,587.00
Rate for Payer: LLUH Dept of Risk Management WC	$1,454.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,983.75

HC CT CHEST W/O CONTRAST

Facility

$4,712.00

Service Code	CPT 71250
Hospital Charge Code	909201912
Hospital Revenue Code	352
Min. Negotiated Rate	$2,591.60
Max. Negotiated Rate	$3,769.60
Rate for Payer: Cash Price	$2,120.40
Rate for Payer: Cigna of CA HMO/PPO	$3,769.60
Rate for Payer: Health Smart Auto/Commercial	$2,827.20
Rate for Payer: LLUH Dept of Risk Management WC	$2,591.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3,534.00

HC CT CHEST W WO CONTRA

Facility

$3,852.00

Service Code	CPT 71270
Hospital Charge Code	909201914
Hospital Revenue Code	352
Min. Negotiated Rate	$2,118.60
Max. Negotiated Rate	$2,889.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2,311.20
Rate for Payer: Aetna of CA Government/Medicare	$2,311.20
Rate for Payer: Cash Price	$1,733.40
Rate for Payer: Health Smart Auto/Commercial	$2,311.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2,311.20
Rate for Payer: LLUH Dept of Risk Management WC	$2,118.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,889.00

HC CT CHEST W WO CONTRA

Facility

$6,862.00

Service Code	CPT 71270 TC
Hospital Charge Code	909201914
Hospital Revenue Code	352
Min. Negotiated Rate	$3,774.10
Max. Negotiated Rate	$5,489.60
Rate for Payer: Cash Price	$3,087.90
Rate for Payer: Cigna of CA HMO/PPO	$5,489.60
Rate for Payer: Health Smart Auto/Commercial	$4,117.20
Rate for Payer: LLUH Dept of Risk Management WC	$3,774.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5,146.50

HC CT CHEST W WO CONTRA

Facility

$6,862.00

Service Code	CPT 71270
Hospital Charge Code	909201914
Hospital Revenue Code	352
Min. Negotiated Rate	$3,774.10
Max. Negotiated Rate	$5,489.60
Rate for Payer: Cash Price	$3,087.90
Rate for Payer: Cigna of CA HMO/PPO	$5,489.60
Rate for Payer: Health Smart Auto/Commercial	$4,117.20
Rate for Payer: LLUH Dept of Risk Management WC	$3,774.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5,146.50

HC CT CSPINE WO CONTRAST

Facility

$3,158.00

Service Code	CPT 72125
Hospital Charge Code	909201915
Hospital Revenue Code	352
Min. Negotiated Rate	$1,736.90
Max. Negotiated Rate	$2,368.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,894.80
Rate for Payer: Aetna of CA Government/Medicare	$1,894.80
Rate for Payer: Cash Price	$1,421.10
Rate for Payer: Health Smart Auto/Commercial	$1,894.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,894.80
Rate for Payer: LLUH Dept of Risk Management WC	$1,736.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,368.50

HC CT CSPINE WO CONTRAST

Facility

$5,624.00

Service Code	CPT 72125 TC
Hospital Charge Code	909201915
Hospital Revenue Code	352
Min. Negotiated Rate	$3,093.20
Max. Negotiated Rate	$4,499.20
Rate for Payer: Cash Price	$2,530.80
Rate for Payer: Cigna of CA HMO/PPO	$4,499.20
Rate for Payer: Health Smart Auto/Commercial	$3,374.40
Rate for Payer: LLUH Dept of Risk Management WC	$3,093.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4,218.00

HC CT CSPINE WO CONTRAST

Facility

$5,624.00

Service Code	CPT 72125
Hospital Charge Code	909201915
Hospital Revenue Code	352
Min. Negotiated Rate	$3,093.20
Max. Negotiated Rate	$4,499.20
Rate for Payer: Cash Price	$2,530.80
Rate for Payer: Cigna of CA HMO/PPO	$4,499.20
Rate for Payer: Health Smart Auto/Commercial	$3,374.40
Rate for Payer: LLUH Dept of Risk Management WC	$3,093.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4,218.00

HC CT C SPINE W/WO CONTRAST

Facility

$3,550.00

Service Code	CPT 72127
Hospital Charge Code	909201967
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 C SPINE W/WO CONTRAST

Facility

$6,357.00

Service Code	CPT 72127 TC
Hospital Charge Code	909201967
Hospital Revenue Code	359
Min. Negotiated Rate	$3,496.35
Max. Negotiated Rate	$5,085.60
Rate for Payer: Cash Price	$2,860.65
Rate for Payer: Cigna of CA HMO/PPO	$5,085.60
Rate for Payer: Health Smart Auto/Commercial	$3,814.20
Rate for Payer: LLUH Dept of Risk Management WC	$3,496.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4,767.75

HC CT C SPINE W/WO CONTRAST

Facility

$3,550.00

Service Code	CPT 72127
Hospital Charge Code	909201967
Hospital Revenue Code	359
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 C SPINE W/WO CONTRAST

Facility

$6,357.00

Service Code	CPT 72127
Hospital Charge Code	909201967
Hospital Revenue Code	352
Min. Negotiated Rate	$3,496.35
Max. Negotiated Rate	$5,085.60
Rate for Payer: Cash Price	$2,860.65
Rate for Payer: Cigna of CA HMO/PPO	$5,085.60
Rate for Payer: Health Smart Auto/Commercial	$3,814.20
Rate for Payer: LLUH Dept of Risk Management WC	$3,496.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4,767.75

HC CT HEAD NO CONTRAST

Facility

$3,125.00

Service Code	CPT 70450
Hospital Charge Code	909201901
Hospital Revenue Code	351
Min. Negotiated Rate	$1,718.75
Max. Negotiated Rate	$2,343.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,875.00
Rate for Payer: Aetna of CA Government/Medicare	$1,875.00
Rate for Payer: Cash Price	$1,406.25
Rate for Payer: Health Smart Auto/Commercial	$1,875.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,875.00
Rate for Payer: LLUH Dept of Risk Management WC	$1,718.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,343.75

HC CT HEAD NO CONTRAST

Facility

$5,320.00

Service Code	CPT 70450 TC
Hospital Charge Code	909201901
Hospital Revenue Code	351
Min. Negotiated Rate	$2,926.00
Max. Negotiated Rate	$4,256.00
Rate for Payer: Cash Price	$2,394.00
Rate for Payer: Cigna of CA HMO/PPO	$4,256.00
Rate for Payer: Health Smart Auto/Commercial	$3,192.00
Rate for Payer: LLUH Dept of Risk Management WC	$2,926.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3,990.00

HC CT HEAD NO CONTRAST

Facility

$5,320.00

Service Code	CPT 70450
Hospital Charge Code	909201901
Hospital Revenue Code	351
Min. Negotiated Rate	$2,926.00
Max. Negotiated Rate	$4,256.00
Rate for Payer: Cash Price	$2,394.00
Rate for Payer: Cigna of CA HMO/PPO	$4,256.00
Rate for Payer: Health Smart Auto/Commercial	$3,192.00
Rate for Payer: LLUH Dept of Risk Management WC	$2,926.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3,990.00

HC CT HEAD W CONTRAST

Facility

$6,208.00

Service Code	CPT 70460 TC
Hospital Charge Code	909201900
Hospital Revenue Code	351
Min. Negotiated Rate	$3,414.40
Max. Negotiated Rate	$4,966.40
Rate for Payer: Cash Price	$2,793.60
Rate for Payer: Cigna of CA HMO/PPO	$4,966.40
Rate for Payer: Health Smart Auto/Commercial	$3,724.80
Rate for Payer: LLUH Dept of Risk Management WC	$3,414.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4,656.00

HC CT HEAD W CONTRAST

Facility

$6,208.00

Service Code	CPT 70460
Hospital Charge Code	909201900
Hospital Revenue Code	351
Min. Negotiated Rate	$3,414.40
Max. Negotiated Rate	$4,966.40
Rate for Payer: Cash Price	$2,793.60
Rate for Payer: Cigna of CA HMO/PPO	$4,966.40
Rate for Payer: Health Smart Auto/Commercial	$3,724.80
Rate for Payer: LLUH Dept of Risk Management WC	$3,414.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4,656.00

HC CT HEAD W CONTRAST

Facility

$3,487.00

Service Code	CPT 70460
Hospital Charge Code	909201900
Hospital Revenue Code	351
Min. Negotiated Rate	$1,917.85
Max. Negotiated Rate	$2,615.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2,092.20
Rate for Payer: Aetna of CA Government/Medicare	$2,092.20
Rate for Payer: Cash Price	$1,569.15
Rate for Payer: Health Smart Auto/Commercial	$2,092.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2,092.20
Rate for Payer: LLUH Dept of Risk Management WC	$1,917.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,615.25

HC CT HEAD W/WO CONTRAS

Facility

$6,450.00

Service Code	CPT 70470 TC
Hospital Charge Code	909201902
Hospital Revenue Code	351
Min. Negotiated Rate	$3,547.50
Max. Negotiated Rate	$5,160.00
Rate for Payer: Cash Price	$2,902.50
Rate for Payer: Cigna of CA HMO/PPO	$5,160.00
Rate for Payer: Health Smart Auto/Commercial	$3,870.00
Rate for Payer: LLUH Dept of Risk Management WC	$3,547.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4,837.50

HC CT HEAD W/WO CONTRAS

Facility

$6,450.00

Service Code	CPT 70470
Hospital Charge Code	909201902
Hospital Revenue Code	351
Min. Negotiated Rate	$3,547.50
Max. Negotiated Rate	$5,160.00
Rate for Payer: Cash Price	$2,902.50
Rate for Payer: Cigna of CA HMO/PPO	$5,160.00
Rate for Payer: Health Smart Auto/Commercial	$3,870.00
Rate for Payer: LLUH Dept of Risk Management WC	$3,547.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4,837.50

HC CT HEAD W/WO CONTRAS

Facility

$3,905.00

Service Code	CPT 70470
Hospital Charge Code	909201902
Hospital Revenue Code	351
Min. Negotiated Rate	$2,147.75
Max. Negotiated Rate	$2,928.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2,343.00
Rate for Payer: Aetna of CA Government/Medicare	$2,343.00
Rate for Payer: Cash Price	$1,757.25
Rate for Payer: Health Smart Auto/Commercial	$2,343.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2,343.00
Rate for Payer: LLUH Dept of Risk Management WC	$2,147.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,928.75

Know your out-of-pocket cost for care.

All Charges