Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC CULTURE ENVIORNMENTAL

Facility

$84.00

Service Code	CPT 87070
Hospital Charge Code	900911532
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 ENVIRONMENTAL

Facility

$390.00

Service Code	CPT 87070
Hospital Charge Code	900912439
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 ENVIRONMENTAL

Facility

$84.00

Service Code	CPT 87070
Hospital Charge Code	900912439
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 FOR TB

Facility

$459.00

Service Code	CPT 87116
Hospital Charge Code	900911526
Hospital Revenue Code	306
Min. Negotiated Rate	$252.45
Max. Negotiated Rate	$367.20
Rate for Payer: Cash Price	$206.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$367.20
Rate for Payer: Health Smart Auto/Commercial	$275.40
Rate for Payer: LLUH Dept of Risk Management WC	$252.45
Rate for Payer: Multiplan Commercial	$344.25

HC CULTURE FOR TB

Facility

$94.00

Service Code	CPT 87116
Hospital Charge Code	900911526
Hospital Revenue Code	306
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$75.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$56.40
Rate for Payer: Aetna of CA Government/Medicare	$56.40
Rate for Payer: Cash Price	$42.30
Rate for Payer: Cash Price	$42.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$75.20
Rate for Payer: Health Smart Auto/Commercial	$56.40
Rate for Payer: Intervalley Health Plan Commercial	$10.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$56.40
Rate for Payer: LLUH Dept of Risk Management WC	$51.70
Rate for Payer: Multiplan Commercial	$70.50

HC CULTURE FOR VIROLOGY

Facility

$165.00

Service Code	CPT 87252
Hospital Charge Code	900911528
Hospital Revenue Code	306
Min. Negotiated Rate	$90.75
Max. Negotiated Rate	$132.00
Rate for Payer: Cash Price	$74.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$132.00
Rate for Payer: Health Smart Auto/Commercial	$99.00
Rate for Payer: LLUH Dept of Risk Management WC	$90.75
Rate for Payer: Multiplan Commercial	$123.75

HC CULTURE FOR VIROLOGY

Facility

$90.00

Service Code	CPT 87252
Hospital Charge Code	900911528
Hospital Revenue Code	306
Min. Negotiated Rate	$26.07
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$54.00
Rate for Payer: Aetna of CA Government/Medicare	$54.00
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$72.00
Rate for Payer: Health Smart Auto/Commercial	$54.00
Rate for Payer: Intervalley Health Plan Commercial	$26.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$54.00
Rate for Payer: LLUH Dept of Risk Management WC	$49.50
Rate for Payer: Multiplan Commercial	$67.50

HC CULTURE FUNGUS (BLOOD)

Facility

$264.00

Service Code	CPT 87103
Hospital Charge Code	900912430
Hospital Revenue Code	306
Min. Negotiated Rate	$145.20
Max. Negotiated Rate	$211.20
Rate for Payer: Cash Price	$118.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$211.20
Rate for Payer: Health Smart Auto/Commercial	$158.40
Rate for Payer: LLUH Dept of Risk Management WC	$145.20
Rate for Payer: Multiplan Commercial	$198.00

HC CULTURE FUNGUS (BLOOD)

Facility

$53.00

Service Code	CPT 87103
Hospital Charge Code	900912430
Hospital Revenue Code	306
Min. Negotiated Rate	$20.46
Max. Negotiated Rate	$42.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$31.80
Rate for Payer: Aetna of CA Government/Medicare	$31.80
Rate for Payer: Cash Price	$23.85
Rate for Payer: Cash Price	$23.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$42.40
Rate for Payer: Health Smart Auto/Commercial	$31.80
Rate for Payer: Intervalley Health Plan Commercial	$20.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$31.80
Rate for Payer: LLUH Dept of Risk Management WC	$29.15
Rate for Payer: Multiplan Commercial	$39.75

HC CULTURE FUNGUS OTHER

Facility

$84.00

Service Code	CPT 87102
Hospital Charge Code	900911523
Hospital Revenue Code	306
Min. Negotiated Rate	$8.41
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	$8.41
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 FUNGUS OTHER

Facility

$353.00

Service Code	CPT 87102
Hospital Charge Code	900911523
Hospital Revenue Code	306
Min. Negotiated Rate	$194.15
Max. Negotiated Rate	$282.40
Rate for Payer: Cash Price	$158.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$282.40
Rate for Payer: Health Smart Auto/Commercial	$211.80
Rate for Payer: LLUH Dept of Risk Management WC	$194.15
Rate for Payer: Multiplan Commercial	$264.75

HC CULTURE FUNGUS(SKIN,HAIR,NAIL)

Facility

$82.00

Service Code	CPT 87101
Hospital Charge Code	900912429
Hospital Revenue Code	306
Min. Negotiated Rate	$7.71
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	$7.71
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 FUNGUS(SKIN,HAIR,NAIL)

Facility

$395.00

Service Code	CPT 87101
Hospital Charge Code	900912429
Hospital Revenue Code	306
Min. Negotiated Rate	$217.25
Max. Negotiated Rate	$316.00
Rate for Payer: Cash Price	$177.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$237.00
Rate for Payer: LLUH Dept of Risk Management WC	$217.25
Rate for Payer: Multiplan Commercial	$296.25

HC CULTURE GASTRIC ASPIRATE

Facility

$390.00

Service Code	CPT 87070
Hospital Charge Code	900911506
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 GASTRIC ASPIRATE

Facility

$84.00

Service Code	CPT 87070
Hospital Charge Code	900911506
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 G.C.

Facility

$82.00

Service Code	CPT 87070
Hospital Charge Code	900911631
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
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	$8.62
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 G.C.

Facility

$390.00

Service Code	CPT 87070
Hospital Charge Code	900911631
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 GRAM NEGATIVE ID

Facility

$72.00

Service Code	CPT 87077
Hospital Charge Code	900912411
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 GRAM NEGATIVE ID

Facility

$200.00

Service Code	CPT 87077
Hospital Charge Code	900912411
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 GRAM POSITIVE ID

Facility

$72.00

Service Code	CPT 87077
Hospital Charge Code	900912410
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 GRAM POSITIVE ID

Facility

$165.00

Service Code	CPT 87077
Hospital Charge Code	900912410
Hospital Revenue Code	306
Min. Negotiated Rate	$90.75
Max. Negotiated Rate	$132.00
Rate for Payer: Cash Price	$74.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$132.00
Rate for Payer: Health Smart Auto/Commercial	$99.00
Rate for Payer: LLUH Dept of Risk Management WC	$90.75
Rate for Payer: Multiplan Commercial	$123.75

HC CULTURE GROUP B STREP

Facility

$390.00

Service Code	CPT 87070
Hospital Charge Code	900912406
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 GROUP B STREP

Facility

$84.00

Service Code	CPT 87070
Hospital Charge Code	900912406
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,INVASIVE LOWER RESP

Facility

$390.00

Service Code	CPT 87070
Hospital Charge Code	900912408
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,INVASIVE LOWER RESP

Facility

$84.00

Service Code	CPT 87070
Hospital Charge Code	900912408
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

Know your out-of-pocket cost for care.

All Charges