Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC CULTURE ENVIORNMENTAL

Facility

$32.00

Service Code	CPT 87070
Hospital Charge Code	900911532
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 ENVIORNMENTAL

Facility

$399.00

Service Code	CPT 87070
Hospital Charge Code	900911532
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 ENVIRONMENTAL

Facility

$399.00

Service Code	CPT 87070
Hospital Charge Code	900912439
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 ENVIRONMENTAL

Facility

$32.00

Service Code	CPT 87070
Hospital Charge Code	900912439
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 FOR TB

Facility

$399.00

Service Code	CPT 87116
Hospital Charge Code	900911526
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 FOR TB

Facility

$41.00

Service Code	CPT 87116
Hospital Charge Code	900911526
Hospital Revenue Code	306
Min. Negotiated Rate	$22.55
Max. Negotiated Rate	$30.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.60
Rate for Payer: Aetna of CA Government/Medicare	$24.60
Rate for Payer: Cash Price	$18.45
Rate for Payer: Health Smart Auto/Commercial	$24.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.60
Rate for Payer: LLUH Dept of Risk Management WC	$22.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.75

HC CULTURE FOR VIROLOGY

Facility

$78.00

Service Code	CPT 87252
Hospital Charge Code	900911528
Hospital Revenue Code	306
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$46.80
Rate for Payer: Aetna of CA Government/Medicare	$46.80
Rate for Payer: Cash Price	$35.10
Rate for Payer: Health Smart Auto/Commercial	$46.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$46.80
Rate for Payer: LLUH Dept of Risk Management WC	$42.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$58.50

HC CULTURE FOR VIROLOGY

Facility

$599.00

Service Code	CPT 87252
Hospital Charge Code	900911528
Hospital Revenue Code	306
Min. Negotiated Rate	$329.45
Max. Negotiated Rate	$479.20
Rate for Payer: Cash Price	$269.55
Rate for Payer: Cigna of CA HMO/PPO	$479.20
Rate for Payer: Health Smart Auto/Commercial	$359.40
Rate for Payer: LLUH Dept of Risk Management WC	$329.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$449.25

HC CULTURE FUNGUS (BLOOD)

Facility

$270.00

Service Code	CPT 87103
Hospital Charge Code	900912430
Hospital Revenue Code	306
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$216.00
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna of CA HMO/PPO	$216.00
Rate for Payer: Health Smart Auto/Commercial	$162.00
Rate for Payer: LLUH Dept of Risk Management WC	$148.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$202.50

HC CULTURE FUNGUS (BLOOD)

Facility

$52.00

Service Code	CPT 87103
Hospital Charge Code	900912430
Hospital Revenue Code	306
Min. Negotiated Rate	$28.60
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$31.20
Rate for Payer: Aetna of CA Government/Medicare	$31.20
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Smart Auto/Commercial	$31.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$31.20
Rate for Payer: LLUH Dept of Risk Management WC	$28.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$39.00

HC CULTURE FUNGUS OTHER

Facility

$361.00

Service Code	CPT 87102
Hospital Charge Code	900911523
Hospital Revenue Code	306
Min. Negotiated Rate	$198.55
Max. Negotiated Rate	$288.80
Rate for Payer: Cash Price	$162.45
Rate for Payer: Cigna of CA HMO/PPO	$288.80
Rate for Payer: Health Smart Auto/Commercial	$216.60
Rate for Payer: LLUH Dept of Risk Management WC	$198.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$270.75

HC CULTURE FUNGUS OTHER

Facility

$32.00

Service Code	CPT 87102
Hospital Charge Code	900911523
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 FUNGUS(SKIN,HAIR,NAIL)

Facility

$399.00

Service Code	CPT 87101
Hospital Charge Code	900912429
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 FUNGUS(SKIN,HAIR,NAIL)

Facility

$52.00

Service Code	CPT 87101
Hospital Charge Code	900912429
Hospital Revenue Code	306
Min. Negotiated Rate	$28.60
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$31.20
Rate for Payer: Aetna of CA Government/Medicare	$31.20
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Smart Auto/Commercial	$31.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$31.20
Rate for Payer: LLUH Dept of Risk Management WC	$28.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$39.00

HC CULTURE GASTRIC ASPIRATE

Facility

$399.00

Service Code	CPT 87070
Hospital Charge Code	900911506
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 GASTRIC ASPIRATE

Facility

$32.00

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

Facility

$399.00

Service Code	CPT 87070
Hospital Charge Code	900911631
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 G.C.

Facility

$31.00

Service Code	CPT 87070
Hospital Charge Code	900911631
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 GRAM NEGATIVE ID

Facility

$204.00

Service Code	CPT 87077
Hospital Charge Code	900912411
Hospital Revenue Code	306
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$163.20
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna of CA HMO/PPO	$163.20
Rate for Payer: Health Smart Auto/Commercial	$122.40
Rate for Payer: LLUH Dept of Risk Management WC	$112.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$153.00

HC CULTURE GRAM NEGATIVE ID

Facility

$31.00

Service Code	CPT 87077
Hospital Charge Code	900912411
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 GRAM POSITIVE ID

Facility

$31.00

Service Code	CPT 87077
Hospital Charge Code	900912410
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 GRAM POSITIVE ID

Facility

$169.00

Service Code	CPT 87077
Hospital Charge Code	900912410
Hospital Revenue Code	306
Min. Negotiated Rate	$92.95
Max. Negotiated Rate	$135.20
Rate for Payer: Cash Price	$76.05
Rate for Payer: Cigna of CA HMO/PPO	$135.20
Rate for Payer: Health Smart Auto/Commercial	$101.40
Rate for Payer: LLUH Dept of Risk Management WC	$92.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$126.75

HC CULTURE GROUP B STREP

Facility

$32.00

Service Code	CPT 87070
Hospital Charge Code	900912406
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 GROUP B STREP

Facility

$399.00

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

Facility

$399.00

Service Code	CPT 87070
Hospital Charge Code	900912408
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