Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC CULTURE BACTERIAL AG H INFLU

Facility

$115.00

Service Code	CPT 87147
Hospital Charge Code	900911711
Hospital Revenue Code	306
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 CULTURE BACTERIAL AG N MENING

Facility

$115.00

Service Code	CPT 87147
Hospital Charge Code	900911713
Hospital Revenue Code	306
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 CULTURE BACTERIAL AG N MENING

Facility

$13.00

Service Code	CPT 87147
Hospital Charge Code	900911713
Hospital Revenue Code	306
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.80
Rate for Payer: Aetna of CA Government/Medicare	$7.80
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC CULTURE BACTERIAL AG S PNEUM

Facility

$13.00

Service Code	CPT 87147
Hospital Charge Code	900911712
Hospital Revenue Code	306
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.80
Rate for Payer: Aetna of CA Government/Medicare	$7.80
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC CULTURE BACTERIAL AG S PNEUM

Facility

$115.00

Service Code	CPT 87147
Hospital Charge Code	900911712
Hospital Revenue Code	306
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 CULTURE BACTERIAL AG STREP B

Facility

$13.00

Service Code	CPT 87147
Hospital Charge Code	900911710
Hospital Revenue Code	306
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.80
Rate for Payer: Aetna of CA Government/Medicare	$7.80
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC CULTURE BACTERIAL AG STREP B

Facility

$115.00

Service Code	CPT 87147
Hospital Charge Code	900911710
Hospital Revenue Code	306
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 CULTURE BLOOD

Facility

$63.00

Service Code	CPT 87040
Hospital Charge Code	900911502
Hospital Revenue Code	306
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$47.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$37.80
Rate for Payer: Aetna of CA Government/Medicare	$37.80
Rate for Payer: Cash Price	$28.35
Rate for Payer: Health Smart Auto/Commercial	$37.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$37.80
Rate for Payer: LLUH Dept of Risk Management WC	$34.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$47.25

HC CULTURE BLOOD

Facility

$399.00

Service Code	CPT 87040
Hospital Charge Code	900911502
Hospital Revenue Code	306
Min. Negotiated Rate	$219.45
Max. Negotiated Rate	$319.20
Rate for Payer: Cash Price	$179.55
Rate for Payer: Cigna of CA HMO/PPO	$319.20
Rate for Payer: Health Smart Auto/Commercial	$239.40
Rate for Payer: LLUH Dept of Risk Management WC	$219.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$299.25

HC CULTURE BODY FLUID

Facility

$32.00

Service Code	CPT 87070
Hospital Charge Code	900911503
Hospital Revenue Code	306
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.20
Rate for Payer: Aetna of CA Government/Medicare	$19.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Smart Auto/Commercial	$19.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.20
Rate for Payer: LLUH Dept of Risk Management WC	$17.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.00

HC CULTURE BODY FLUID

Facility

$399.00

Service Code	CPT 87070
Hospital Charge Code	900911503
Hospital Revenue Code	306
Min. Negotiated Rate	$219.45
Max. Negotiated Rate	$319.20
Rate for Payer: Cash Price	$179.55
Rate for Payer: Cigna of CA HMO/PPO	$319.20
Rate for Payer: Health Smart Auto/Commercial	$239.40
Rate for Payer: LLUH Dept of Risk Management WC	$219.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$299.25

HC CULTURE BORDATELLA PERTUSS

Facility

$32.00

Service Code	CPT 87070
Hospital Charge Code	900911521
Hospital Revenue Code	306
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.20
Rate for Payer: Aetna of CA Government/Medicare	$19.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Smart Auto/Commercial	$19.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.20
Rate for Payer: LLUH Dept of Risk Management WC	$17.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.00

HC CULTURE BORDATELLA PERTUSS

Facility

$399.00

Service Code	CPT 87070
Hospital Charge Code	900911521
Hospital Revenue Code	306
Min. Negotiated Rate	$219.45
Max. Negotiated Rate	$319.20
Rate for Payer: Cash Price	$179.55
Rate for Payer: Cigna of CA HMO/PPO	$319.20
Rate for Payer: Health Smart Auto/Commercial	$239.40
Rate for Payer: LLUH Dept of Risk Management WC	$219.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$299.25

HC CULTURE BRONCHIAL WASH/BRUSH

Facility

$32.00

Service Code	CPT 87070
Hospital Charge Code	900911504
Hospital Revenue Code	306
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.20
Rate for Payer: Aetna of CA Government/Medicare	$19.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Smart Auto/Commercial	$19.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.20
Rate for Payer: LLUH Dept of Risk Management WC	$17.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.00

HC CULTURE BRONCHIAL WASH/BRUSH

Facility

$399.00

Service Code	CPT 87070
Hospital Charge Code	900911504
Hospital Revenue Code	306
Min. Negotiated Rate	$219.45
Max. Negotiated Rate	$319.20
Rate for Payer: Cash Price	$179.55
Rate for Payer: Cigna of CA HMO/PPO	$319.20
Rate for Payer: Health Smart Auto/Commercial	$239.40
Rate for Payer: LLUH Dept of Risk Management WC	$219.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$299.25

HC CULTURE CATHETER TIP

Facility

$399.00

Service Code	CPT 87070
Hospital Charge Code	900912437
Hospital Revenue Code	306
Min. Negotiated Rate	$219.45
Max. Negotiated Rate	$319.20
Rate for Payer: Cash Price	$179.55
Rate for Payer: Cigna of CA HMO/PPO	$319.20
Rate for Payer: Health Smart Auto/Commercial	$239.40
Rate for Payer: LLUH Dept of Risk Management WC	$219.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$299.25

HC CULTURE CATHETER TIP

Facility

$32.00

Service Code	CPT 87070
Hospital Charge Code	900912437
Hospital Revenue Code	306
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.20
Rate for Payer: Aetna of CA Government/Medicare	$19.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Smart Auto/Commercial	$19.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.20
Rate for Payer: LLUH Dept of Risk Management WC	$17.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.00

HC CULTURE CLO TEST

Facility

$31.00

Service Code	CPT 87077
Hospital Charge Code	900910670
Hospital Revenue Code	306
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.60
Rate for Payer: Aetna of CA Government/Medicare	$18.60
Rate for Payer: Cash Price	$13.95
Rate for Payer: Health Smart Auto/Commercial	$18.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.60
Rate for Payer: LLUH Dept of Risk Management WC	$17.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$23.25

HC CULTURE CLO TEST

Facility

$136.00

Service Code	CPT 87077
Hospital Charge Code	900910670
Hospital Revenue Code	306
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$108.80
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cigna of CA HMO/PPO	$108.80
Rate for Payer: Health Smart Auto/Commercial	$81.60
Rate for Payer: LLUH Dept of Risk Management WC	$74.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$102.00

HC CULTURE CRYPTOCOCCUS SCREEN

Facility

$115.00

Service Code	CPT 87147
Hospital Charge Code	900911610
Hospital Revenue Code	306
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 CULTURE CRYPTOCOCCUS SCREEN

Facility

$20.00

Service Code	CPT 87147
Hospital Charge Code	900911610
Hospital Revenue Code	306
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.00
Rate for Payer: Aetna of CA Government/Medicare	$12.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.00

HC CULTURE CSF

Facility

$399.00

Service Code	CPT 87070
Hospital Charge Code	900911505
Hospital Revenue Code	306
Min. Negotiated Rate	$219.45
Max. Negotiated Rate	$319.20
Rate for Payer: Cash Price	$179.55
Rate for Payer: Cigna of CA HMO/PPO	$319.20
Rate for Payer: Health Smart Auto/Commercial	$239.40
Rate for Payer: LLUH Dept of Risk Management WC	$219.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$299.25

HC CULTURE CSF

Facility

$32.00

Service Code	CPT 87070
Hospital Charge Code	900911505
Hospital Revenue Code	306
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.20
Rate for Payer: Aetna of CA Government/Medicare	$19.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Smart Auto/Commercial	$19.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.20
Rate for Payer: LLUH Dept of Risk Management WC	$17.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.00

HC CULTURE CYSTIC FIBROSIS

Facility

$32.00

Service Code	CPT 87070
Hospital Charge Code	900911533
Hospital Revenue Code	306
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.20
Rate for Payer: Aetna of CA Government/Medicare	$19.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Smart Auto/Commercial	$19.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.20
Rate for Payer: LLUH Dept of Risk Management WC	$17.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.00

HC CULTURE CYSTIC FIBROSIS

Facility

$399.00

Service Code	CPT 87070
Hospital Charge Code	900911533
Hospital Revenue Code	306
Min. Negotiated Rate	$219.45
Max. Negotiated Rate	$319.20
Rate for Payer: Cash Price	$179.55
Rate for Payer: Cigna of CA HMO/PPO	$319.20
Rate for Payer: Health Smart Auto/Commercial	$239.40
Rate for Payer: LLUH Dept of Risk Management WC	$219.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$299.25

Know your out-of-pocket cost for care.

All Charges