Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC CULTURE BACTERIAL AG N MENING

Facility

$132.00

Service Code	CPT 87147
Hospital Charge Code	900911713
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 N MENING

Facility

$46.00

Service Code	CPT 87147
Hospital Charge Code	900911713
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

HC CULTURE BACTERIAL AG S PNEUM

Facility

$46.00

Service Code	CPT 87147
Hospital Charge Code	900911712
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

HC CULTURE BACTERIAL AG S PNEUM

Facility

$132.00

Service Code	CPT 87147
Hospital Charge Code	900911712
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 STREP B

Facility

$132.00

Service Code	CPT 87147
Hospital Charge Code	900911710
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 STREP B

Facility

$46.00

Service Code	CPT 87147
Hospital Charge Code	900911710
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

HC CULTURE BLOOD

Facility

$390.00

Service Code	CPT 87040
Hospital Charge Code	900911502
Hospital Revenue Code	306
Min. Negotiated Rate	$214.50
Max. Negotiated Rate	$312.00
Rate for Payer: Cash Price	$175.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$312.00
Rate for Payer: Health Smart Auto/Commercial	$234.00
Rate for Payer: LLUH Dept of Risk Management WC	$214.50
Rate for Payer: Multiplan Commercial	$292.50

HC CULTURE BLOOD

Facility

$110.00

Service Code	CPT 87040
Hospital Charge Code	900911502
Hospital Revenue Code	306
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$88.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$66.00
Rate for Payer: Aetna of CA Government/Medicare	$66.00
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$88.00
Rate for Payer: Health Smart Auto/Commercial	$66.00
Rate for Payer: Intervalley Health Plan Commercial	$10.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$66.00
Rate for Payer: LLUH Dept of Risk Management WC	$60.50
Rate for Payer: Multiplan Commercial	$82.50

HC CULTURE BODY FLUID

Facility

$84.00

Service Code	CPT 87070
Hospital Charge Code	900911503
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$67.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$50.40
Rate for Payer: Aetna of CA Government/Medicare	$50.40
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cash Price	$37.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$67.20
Rate for Payer: Health Smart Auto/Commercial	$50.40
Rate for Payer: Intervalley Health Plan Commercial	$8.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$50.40
Rate for Payer: LLUH Dept of Risk Management WC	$46.20
Rate for Payer: Multiplan Commercial	$63.00

HC CULTURE BODY FLUID

Facility

$390.00

Service Code	CPT 87070
Hospital Charge Code	900911503
Hospital Revenue Code	306
Min. Negotiated Rate	$214.50
Max. Negotiated Rate	$312.00
Rate for Payer: Cash Price	$175.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$312.00
Rate for Payer: Health Smart Auto/Commercial	$234.00
Rate for Payer: LLUH Dept of Risk Management WC	$214.50
Rate for Payer: Multiplan Commercial	$292.50

HC CULTURE BORDATELLA PERTUSS

Facility

$84.00

Service Code	CPT 87070
Hospital Charge Code	900911521
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$67.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$50.40
Rate for Payer: Aetna of CA Government/Medicare	$50.40
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cash Price	$37.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$67.20
Rate for Payer: Health Smart Auto/Commercial	$50.40
Rate for Payer: Intervalley Health Plan Commercial	$8.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$50.40
Rate for Payer: LLUH Dept of Risk Management WC	$46.20
Rate for Payer: Multiplan Commercial	$63.00

HC CULTURE BORDATELLA PERTUSS

Facility

$390.00

Service Code	CPT 87070
Hospital Charge Code	900911521
Hospital Revenue Code	306
Min. Negotiated Rate	$214.50
Max. Negotiated Rate	$312.00
Rate for Payer: Cash Price	$175.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$312.00
Rate for Payer: Health Smart Auto/Commercial	$234.00
Rate for Payer: LLUH Dept of Risk Management WC	$214.50
Rate for Payer: Multiplan Commercial	$292.50

HC CULTURE BRONCHIAL WASH/BRUSH

Facility

$390.00

Service Code	CPT 87070
Hospital Charge Code	900911504
Hospital Revenue Code	306
Min. Negotiated Rate	$214.50
Max. Negotiated Rate	$312.00
Rate for Payer: Cash Price	$175.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$312.00
Rate for Payer: Health Smart Auto/Commercial	$234.00
Rate for Payer: LLUH Dept of Risk Management WC	$214.50
Rate for Payer: Multiplan Commercial	$292.50

HC CULTURE BRONCHIAL WASH/BRUSH

Facility

$84.00

Service Code	CPT 87070
Hospital Charge Code	900911504
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$67.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$50.40
Rate for Payer: Aetna of CA Government/Medicare	$50.40
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cash Price	$37.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$67.20
Rate for Payer: Health Smart Auto/Commercial	$50.40
Rate for Payer: Intervalley Health Plan Commercial	$8.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$50.40
Rate for Payer: LLUH Dept of Risk Management WC	$46.20
Rate for Payer: Multiplan Commercial	$63.00

HC CULTURE CATHETER TIP

Facility

$84.00

Service Code	CPT 87070
Hospital Charge Code	900912437
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$67.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$50.40
Rate for Payer: Aetna of CA Government/Medicare	$50.40
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cash Price	$37.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$67.20
Rate for Payer: Health Smart Auto/Commercial	$50.40
Rate for Payer: Intervalley Health Plan Commercial	$8.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$50.40
Rate for Payer: LLUH Dept of Risk Management WC	$46.20
Rate for Payer: Multiplan Commercial	$63.00

HC CULTURE CATHETER TIP

Facility

$390.00

Service Code	CPT 87070
Hospital Charge Code	900912437
Hospital Revenue Code	306
Min. Negotiated Rate	$214.50
Max. Negotiated Rate	$312.00
Rate for Payer: Cash Price	$175.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$312.00
Rate for Payer: Health Smart Auto/Commercial	$234.00
Rate for Payer: LLUH Dept of Risk Management WC	$214.50
Rate for Payer: Multiplan Commercial	$292.50

HC CULTURE CLO TEST

Facility

$72.00

Service Code	CPT 87077
Hospital Charge Code	900910670
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 CLO TEST

Facility

$133.00

Service Code	CPT 87077
Hospital Charge Code	900910670
Hospital Revenue Code	306
Min. Negotiated Rate	$73.15
Max. Negotiated Rate	$106.40
Rate for Payer: Cash Price	$59.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$106.40
Rate for Payer: Health Smart Auto/Commercial	$79.80
Rate for Payer: LLUH Dept of Risk Management WC	$73.15
Rate for Payer: Multiplan Commercial	$99.75

HC CULTURE CRYPTOCOCCUS SCREEN

Facility

$132.00

Service Code	CPT 87147
Hospital Charge Code	900911610
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 CRYPTOCOCCUS SCREEN

Facility

$46.00

Service Code	CPT 87147
Hospital Charge Code	900911610
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

HC CULTURE CSF

Facility

$84.00

Service Code	CPT 87070
Hospital Charge Code	900911505
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$67.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$50.40
Rate for Payer: Aetna of CA Government/Medicare	$50.40
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cash Price	$37.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$67.20
Rate for Payer: Health Smart Auto/Commercial	$50.40
Rate for Payer: Intervalley Health Plan Commercial	$8.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$50.40
Rate for Payer: LLUH Dept of Risk Management WC	$46.20
Rate for Payer: Multiplan Commercial	$63.00

HC CULTURE CSF

Facility

$390.00

Service Code	CPT 87070
Hospital Charge Code	900911505
Hospital Revenue Code	306
Min. Negotiated Rate	$214.50
Max. Negotiated Rate	$312.00
Rate for Payer: Cash Price	$175.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$312.00
Rate for Payer: Health Smart Auto/Commercial	$234.00
Rate for Payer: LLUH Dept of Risk Management WC	$214.50
Rate for Payer: Multiplan Commercial	$292.50

HC CULTURE CYSTIC FIBROSIS

Facility

$390.00

Service Code	CPT 87070
Hospital Charge Code	900911533
Hospital Revenue Code	306
Min. Negotiated Rate	$214.50
Max. Negotiated Rate	$312.00
Rate for Payer: Cash Price	$175.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$312.00
Rate for Payer: Health Smart Auto/Commercial	$234.00
Rate for Payer: LLUH Dept of Risk Management WC	$214.50
Rate for Payer: Multiplan Commercial	$292.50

HC CULTURE CYSTIC FIBROSIS

Facility

$84.00

Service Code	CPT 87070
Hospital Charge Code	900911533
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$67.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$50.40
Rate for Payer: Aetna of CA Government/Medicare	$50.40
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cash Price	$37.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$67.20
Rate for Payer: Health Smart Auto/Commercial	$50.40
Rate for Payer: Intervalley Health Plan Commercial	$8.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$50.40
Rate for Payer: LLUH Dept of Risk Management WC	$46.20
Rate for Payer: Multiplan Commercial	$63.00

HC CULTURE ENVIORNMENTAL

Facility

$390.00

Service Code	CPT 87070
Hospital Charge Code	900911532
Hospital Revenue Code	306
Min. Negotiated Rate	$214.50
Max. Negotiated Rate	$312.00
Rate for Payer: Cash Price	$175.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$312.00
Rate for Payer: Health Smart Auto/Commercial	$234.00
Rate for Payer: LLUH Dept of Risk Management WC	$214.50
Rate for Payer: Multiplan Commercial	$292.50

Know your out-of-pocket cost for care.

All Charges