Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC CULTURE JEJUNUM AEROBIC

Facility

$390.00

Service Code	CPT 87071
Hospital Charge Code	900911507
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 JEJUNUM AEROBIC

Facility

$39.00

Service Code	CPT 87071
Hospital Charge Code	900911507
Hospital Revenue Code	306
Min. Negotiated Rate	$9.89
Max. Negotiated Rate	$31.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.40
Rate for Payer: Aetna of CA Government/Medicare	$23.40
Rate for Payer: Cash Price	$17.55
Rate for Payer: Cash Price	$17.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$31.20
Rate for Payer: Health Smart Auto/Commercial	$23.40
Rate for Payer: Intervalley Health Plan Commercial	$9.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.40
Rate for Payer: LLUH Dept of Risk Management WC	$21.45
Rate for Payer: Multiplan Commercial	$29.25

HC CULTURE JEJUNUM ANAEROBIC

Facility

$429.00

Service Code	CPT 87073
Hospital Charge Code	900911508
Hospital Revenue Code	306
Min. Negotiated Rate	$235.95
Max. Negotiated Rate	$343.20
Rate for Payer: Cash Price	$193.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$343.20
Rate for Payer: Health Smart Auto/Commercial	$257.40
Rate for Payer: LLUH Dept of Risk Management WC	$235.95
Rate for Payer: Multiplan Commercial	$321.75

HC CULTURE JEJUNUM ANAEROBIC

Facility

$39.00

Service Code	CPT 87073
Hospital Charge Code	900911508
Hospital Revenue Code	306
Min. Negotiated Rate	$9.66
Max. Negotiated Rate	$31.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.40
Rate for Payer: Aetna of CA Government/Medicare	$23.40
Rate for Payer: Cash Price	$17.55
Rate for Payer: Cash Price	$17.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$31.20
Rate for Payer: Health Smart Auto/Commercial	$23.40
Rate for Payer: Intervalley Health Plan Commercial	$9.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.40
Rate for Payer: LLUH Dept of Risk Management WC	$21.45
Rate for Payer: Multiplan Commercial	$29.25

HC CULTURE LEGIONELLA

Facility

$390.00

Service Code	CPT 87070
Hospital Charge Code	900911524
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 LEGIONELLA

Facility

$84.00

Service Code	CPT 87070
Hospital Charge Code	900911524
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 MISCELLANEOUS

Facility

$84.00

Service Code	CPT 87070
Hospital Charge Code	900911509
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 MISCELLANEOUS

Facility

$390.00

Service Code	CPT 87070
Hospital Charge Code	900911509
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 MOLD ID

Facility

$281.00

Service Code	CPT 87107
Hospital Charge Code	900911560
Hospital Revenue Code	306
Min. Negotiated Rate	$154.55
Max. Negotiated Rate	$224.80
Rate for Payer: Cash Price	$126.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$224.80
Rate for Payer: Health Smart Auto/Commercial	$168.60
Rate for Payer: LLUH Dept of Risk Management WC	$154.55
Rate for Payer: Multiplan Commercial	$210.75

HC CULTURE MOLD ID

Facility

$98.00

Service Code	CPT 87107
Hospital Charge Code	900911560
Hospital Revenue Code	306
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$78.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$58.80
Rate for Payer: Aetna of CA Government/Medicare	$58.80
Rate for Payer: Cash Price	$44.10
Rate for Payer: Cash Price	$44.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$78.40
Rate for Payer: Health Smart Auto/Commercial	$58.80
Rate for Payer: Intervalley Health Plan Commercial	$10.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$58.80
Rate for Payer: LLUH Dept of Risk Management WC	$53.90
Rate for Payer: Multiplan Commercial	$73.50

HC CULTURE MRSA SURVELLIANCE

Facility

$84.00

Service Code	CPT 87070
Hospital Charge Code	900912438
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 MRSA SURVELLIANCE

Facility

$332.00

Service Code	CPT 87070
Hospital Charge Code	900912438
Hospital Revenue Code	306
Min. Negotiated Rate	$182.60
Max. Negotiated Rate	$265.60
Rate for Payer: Cash Price	$149.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$265.60
Rate for Payer: Health Smart Auto/Commercial	$199.20
Rate for Payer: LLUH Dept of Risk Management WC	$182.60
Rate for Payer: Multiplan Commercial	$249.00

HC CULTURE NEISS/HAEM RAPID ID

Facility

$200.00

Service Code	CPT 87077
Hospital Charge Code	900912428
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 NEISS/HAEM RAPID ID

Facility

$72.00

Service Code	CPT 87077
Hospital Charge Code	900912428
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 NON-FERMENT ID

Facility

$72.00

Service Code	CPT 87077
Hospital Charge Code	900912426
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 NON-FERMENT ID

Facility

$200.00

Service Code	CPT 87077
Hospital Charge Code	900912426
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 OPTIC

Facility

$459.00

Service Code	CPT 87077
Hospital Charge Code	900911510
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 OPTIC

Facility

$74.00

Service Code	CPT 87077
Hospital Charge Code	900911510
Hospital Revenue Code	306
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$59.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$44.40
Rate for Payer: Aetna of CA Government/Medicare	$44.40
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cash Price	$33.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$59.20
Rate for Payer: Health Smart Auto/Commercial	$44.40
Rate for Payer: Intervalley Health Plan Commercial	$8.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$44.40
Rate for Payer: LLUH Dept of Risk Management WC	$40.70
Rate for Payer: Multiplan Commercial	$55.50

HC CULTURE OTIC

Facility

$390.00

Service Code	CPT 87070
Hospital Charge Code	900911512
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 OTIC

Facility

$84.00

Service Code	CPT 87070
Hospital Charge Code	900911512
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 PBP2 LATEX AGGLUTINATION

Facility

$43.00

Service Code	CPT 87147
Hospital Charge Code	900912417
Hospital Revenue Code	306
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$34.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$25.80
Rate for Payer: Aetna of CA Government/Medicare	$25.80
Rate for Payer: Cash Price	$19.35
Rate for Payer: Cash Price	$19.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$34.40
Rate for Payer: Health Smart Auto/Commercial	$25.80
Rate for Payer: Intervalley Health Plan Commercial	$5.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$25.80
Rate for Payer: LLUH Dept of Risk Management WC	$23.65
Rate for Payer: Multiplan Commercial	$32.25

HC CULTURE PBP2 LATEX AGGLUTINATION

Facility

$156.00

Service Code	CPT 87147
Hospital Charge Code	900912417
Hospital Revenue Code	306
Min. Negotiated Rate	$85.80
Max. Negotiated Rate	$124.80
Rate for Payer: Cash Price	$70.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$124.80
Rate for Payer: Health Smart Auto/Commercial	$93.60
Rate for Payer: LLUH Dept of Risk Management WC	$85.80
Rate for Payer: Multiplan Commercial	$117.00

HC CULTURE QUANT AEROBIC

Facility

$390.00

Service Code	CPT 87071
Hospital Charge Code	900912433
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 QUANT AEROBIC

Facility

$73.00

Service Code	CPT 87071
Hospital Charge Code	900912433
Hospital Revenue Code	306
Min. Negotiated Rate	$9.89
Max. Negotiated Rate	$58.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$43.80
Rate for Payer: Aetna of CA Government/Medicare	$43.80
Rate for Payer: Cash Price	$32.85
Rate for Payer: Cash Price	$32.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$58.40
Rate for Payer: Health Smart Auto/Commercial	$43.80
Rate for Payer: Intervalley Health Plan Commercial	$9.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$43.80
Rate for Payer: LLUH Dept of Risk Management WC	$40.15
Rate for Payer: Multiplan Commercial	$54.75

HC CULTURE QUANT ANAEROBIC

Facility

$429.00

Service Code	CPT 87073
Hospital Charge Code	900912434
Hospital Revenue Code	306
Min. Negotiated Rate	$235.95
Max. Negotiated Rate	$343.20
Rate for Payer: Cash Price	$193.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$343.20
Rate for Payer: Health Smart Auto/Commercial	$257.40
Rate for Payer: LLUH Dept of Risk Management WC	$235.95
Rate for Payer: Multiplan Commercial	$321.75

Know your out-of-pocket cost for care.

All Charges